The URL can be used to link to this page

1540 Thomas Lake PtN G SEWER SERVICE PERMIT A CITY OF EA 9807 3830 Pilot Knob Road PERMIT NO.: P.O. Box 21199 Eagan, MN 55121 DATE: 50 & 1 Car Wash Unit Zoning: No. of Units: Domain Const. Owner. Address: 1540 Tho s Lake Poin e 1.4 B1 'r"homas LA Po to Site Address: Consolidat d Plumber. 12-31-85 19 4 880.OOpd ith the l I g Cgot"d fil t9039e: - y w I agree to comp Ordlnsneas. TEL RH ONE - 4 - a*: Perm A` Vrg REQUIRED - Misc. Charges: BY Total: Date of Insp.: Date Paid: lnsp : CITY OF EAGAN SEWER 5 3830 PW Knob Road PERMIT NO.: P.O. Box 21199 DATE: Eagan, MN 5 R4 NO. of Units. Zoning: Domain Const. Owner. Address: ,,,, a e a e Po in -6 L Site Address: Plumber. - 1 agree to comply with the City of Ordinances. BY - Date of Insp.: Insp.: CITY OF EAGAN 3830 Pilot Knob Road P.O. Box 21199 Eagan, MN 55x7?1 Zoning: - ,. Owner. ?--- Address: 1540 1 Site Address: Consol plumber h 1 agree to comply with Ordinances. r. BY Date of Insp.: - Insp.: cohno6tion Charge: 23 180 0 /Account Deposit: IQ??D4d Permiffee: ?0 n d Surcharge: _ Misc. Charges: Total: Date Paid: SEWER SERVICE PoERMIT 98 PERMIT NO.: of Units: itite L4 BI Thomas Lk Pointrs n 4,g80.00nd Connection Charge: Account Deposit: Permi? f ee: Surcharge: Misc. Charges: _ Total: _ Date Paid: CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot K- -b Road 9 , P.O. Box §7199 PERMIT NO.: Eagan, MN 551?1, DATE: ,- - ? Zonin g: No. of Units: Owne on r. n Address: ' . ?'7 4, omas LaRK, Site Address: Pointe LA .17L o n e ,onso a e nm Plumber. P ng 3 9 r) , 1 agree to comply with the City of Eagan Connection Charge: 2 _', s 1 00 Ordinances. Account Deposit: Permit Fee: l P. GJnry Surcharge. By Misc. Charges: CITY OF EAGAN Permit No. Date: 4-20--E7 3830 PBotXnob Road Meter No. Size: P.O - it21199 Reader No: Date: Eagan, MN 55121 Owner. Domalln Jogat. Site Address: 1540 7hafta Lake Pointe 1A B1 A Lk Points Conn. Chg; ?'' vvv. vvpu zoning: Acct Dep: No. of Units: 60 6 I Car Wash Un j Permit Fee. I0.00pd Surcharge: • 50pd I agree to comply with the City of Eagan ! 7,625.00pd Tr. Plant Ordinances. Meter. By WATER SERVICE PERMIT e CITY OF EAGAN f 13070 ., .y 3830 PIIot Knob Road, P.O. Box 21-199, Eagan, M N 55121 ' PHONE' 454-8100# ' BUILDING PERMI T ' Receipt #1 "D .11 $1 , 725 r 00% DECEMBER 31 19 6 To 161 updtor Est Value ate Site Address POINTE Erect OX Occupancy RUBI Lot Block Sec/Sub. '0AAS LAKE P01AW ilei ? R ? Zoning t V 1 HR 11 iJ s p, T f C n Parcel No. epair t ? ype o o s i N St 3 Addi ion o. or es e 1 )OS I NG OC I A 1 (Me ? demolish ? 7 7 length Depth f7 11Address Int. Impr. ? Sq. Fr ) 0 0 P 1711 hone Install ? Phone Name )N, SHELDON 5 sorensen = Address '414 YF.LLOW CIR DR 935-6337 5 M City Phone Assessment Water 8 Sew. Police Fire Eng. Planner Council Permit '' Surcharge 101 -7 9 __ *0' .0 an SAC- Water Water c Road I hereby acknowledge that I have read this application and state that the Bldg- OH. Tr. PI. 7, 025. Information Is correct and agree to comply with all applicable State of ; % A Minnesota Statutes and City of Eagan Ordinances. APC Parks Var. Date Copies Signature of Permittee Total ? 81, 13 ?i. 2' A Building Permit is Issued to: i)6TdX 1,V CONS RU PORE I NC on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official . 01 Os 4% Permit No. Pad M older Daft Telephone N Plumbing / r L" `"/// /h H.Y.11. 7115A'2 Inspecdon Dow Imp. comn"Wds Foolk I i i Footings H Feundetlon 5 tG c" q. 7 r i e ' Fronklnp -/? Y Lr. n?s r 1 / d rG 7 S 7' i .1 ff? [? D Raw d 7- 9 .? ?. 9. ?-} Rough Plop. 3-cr7 - Rough NIp A - Insul. -0-AO'. Fireplace - Fkkal "lg. P 44, 7 At -17 Final Plbg. Mg. Final cert. Dkx. Deck Ftg. Deck Fmg. WON Pr. Mp. 7 C • N^ ?? G 4.?! r? it r ' sis 4AA .S Mi 11 1 y 46 (Irruttrafr of Orrupaury citp of (Eagan This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following. 4 Use CL ffiMd0m Bldg. Fb m t No. OWUPS-Y Type TH ? ? C 1 OwwofBuiWM T"liiljrlA; ); ti FATA)R f.N. M L,i L4, B1, 'rHDMA-S--U,7KE= Bu7diu4 Addreu Loality Due: Bmldis ORidid POST IN A CONSPICUOUS PLACE J larfivoon (gertifiratr of (Orruvaury Citp of eagan lorprtmmt of sing jnwrrtton This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following. • tie CLeei&aooo &dt. Rani( No. Da(e: Yi BuMiq OtScie] POST IN A CONSPICUOUS PLACE PERMIT # MECHANICAL PERMIT CITY OF EAGAN RECEIPT # 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE TRACT PRICE:' ?C `I PHONE; 4S4-8100 Site Address ' " , BLDG. TYPE WORK DESCRIPTION Lot Block ec/Sub I. Res. New - Mult 1 Add-on m Name > Comm. Repair Address Other c City Phone ' ?7- = Name - c Address p City - TYPE OF WORK Forced Air Boiler Mnit Heater Air Cond. Vent Gas Piping Outlets # Other /1"& A, M BTU M BTU M BTU M BTU CFM F,•1 4 FEES/C: TOTAL FEES RES. HVAC 0-100 M BTU -$24.00 ADDITIONAL 50 M BTU - 6.00 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1.50 EA. COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES, RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON & REMODELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000) SIGNATURE OF PERMITTEE FQR: CITY OF EAGAN ??sE,e?s ??? - ?i? - ?i? PERMIT 8 :Y ;;? A PLUMBING PERMIT 72 CITY OF EAGAN RECEIPT ii / / 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: '// ?! & 7 T PRICE / 7 Z1 a w y PHONE: 454-8100 Site Address !91- zvel 4 Lot Block -L, rT m Name ?o tS -y Address c city, $1s a? c 3 O Name _ Address City Phone FEES COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS - COMM RATE APPLIES TOWNHOUSE & CONDO - RES. RATE APPLIES MINIMUM - RESIDENTIAL FEE -$12.00 MINIMUM - COMM/IND FEE -$20-00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES FOR: CITY OF EAGAN BLDG. TYPE WORK DESCRIPTION Res. New y Mult. y Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING: N FIXTURES TOTAL --9-0-Water Closet - $3.00 $ Bath Tubs - $3.00 _ 01-avatory - $3.00 --Z.7Shower - $3.00 -AKQKitchen Sink - $3.00 Urinal/Bidet - $3.00 Laundry Tray - $100 ::?qloor Drains - $1.50 AtZWater Heater - $1.50 Whirlpool - $3.00 Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMIT) .1_Sottener - $5.00 Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 FEE:J STATE S/C: J GRAND TOTAL. f ? C??.??r ate. 7-is-F7 ?-rel. ?• ?•?= , ,6-v...? ', 77 ,3,4 ? J • 3830 Pilot Knob RoadCTY OF ! P.O. Box 2G-A1 9, Eagan, MN 55121 ` 1 Z 9 4 5 BUILDING PERMIT PHONE: 454-8100 ' J Receipt N To be ua@d for FOUNDATION Est. Value Date D ECE14BER 8 19 _8_6_ Site Address 1540 THOMAS L AKE POINTE Erect 17, occupancy Lot 4 Block I Sec/Sub THOMAS LK POINBOodel ? Zoning . Parcel No Repair ? Type of Const. . Addition ? No. Stories Name THOMAS LK H OUSING ASSOC Move ? Demolish ? Length Depth o Address 3140 HARBOR LN Int. Impr. ? Sq. Ft. City PLYMOI Wkbne 55 9-1711 Install ? o Name DOMAIN CONSTRUCTORS INC Address SAME ~ City Phone F W Name a Address z < W City Phone Assessment Water 8 Sew. Police Fire Planner Council Bldg. 01 Surcharge Plan Review Water Conn. Water Meter Road Unit Tr. PI. I hereby acknowledge that I have read this application and state thatthe information is correct and agree to comply with all applicable State pf Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is Issued to: DOMAIN CONSTRUCTORS all work shall be done in accordance with all applicable State of Minnesotf Var. Date I Copi Total INC on the express condition that Statutes and City of Eagan Ordinances. Building Official /LY i u _ . 1 PenMl No. I Pamnlt Molds I Dale Tdapho- N Daft 1 DMp. INSPECTION, DATE INSPECTOR COMMENTS O i0ir ?.? ?i A? 30 s - ol SITE ADDRESS l? ?9u IQIJ(i Unit Permit /?li7G L B Sect /Sub. INSPECTION DATE INSPECTOR OTHER FRAMING ROUGN PLGG. ROUGN NTG. INSUL REPLACE FINAL NTt. RNAL PLH. UNIT RNAL T CER /OCC This request vd.0 7 18 man Ills from ???? C 13818 1,1 /2S' 7uGlt 9 Request Data =27 `a? =('' Fue No. Roughen Inspeclinn R T equiretlr ?Reatly Nuw ? Will Notify Insper,- _? Elves ?No tur When Ready LLtcensed Electrical Contractor I hereby request inspection of above ? Owner electncel work installed at: Street Address, Box or Route No. 1 City coon o. Township ame or No. Range No. Co y Occupant (PRINT) Phone No. wer Supplier Address e Ir at Contractor ( ompany Name) - ?) 1,1 Cnntr t . s License No. 0SZ2-3 Mailing Address nbactor or Owner Making Installation) -35"7 n57v h/ ?Syl6 Authorized Sig ore (Contractor nor M It Install ton Phonq Number M NES'9 A STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Grigg T•• dway Bldg. - Room N•191 BE ACCEPTED BY THE STATE BOARD 1821 'University Ave., St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phono 16121297.2111 ENCLOSED. 5149/$;' - REQUEST FOR ELECTRICAL INSPECTION EB-00001-04 Ak? 1 See instructions for completing this loan on beck of yellow copy. C'13818 X" Below Work Covered by This Request New and Rep. Tv eptJdmg Appliances Wired Equipment Wired 'Home Range Temporary Service Duplex Water Heater Lighting Fizttues Apt. Building Dryer Electric Hearn Commercial Bldg Furnace Silo Unloader. Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other peu v lhvr IS11ee0y1 tuv Suac Hy Cher Othpr- Compute Inspection Fee Below Jr, Fee Service Entrance Size it --- Fee -------- FBBdersrSabiaedele p Fpe circwts 0 to 200 Amps 0 to 30 Am s 'ZCi 0 to 30 Amos Above 200 Amps 31 to 100 Amps 31 to 100 Am Swimming Pool Above 100-Amps Above 100_Amps Transformers Irrigation Booms $O Partial, Other Fee Signs Special Inspection S Z0 Rerrw rks -• TOTAL EE 1 nA ?y. Rough-in ' Date ^(Q ? 1, the Electrical Ins pactor are final r c ? ) Da a ?-1r? At a certi ly tht the Above mspectmn has has. en made. This request void 18 months from This request void 18 months from 7 ?"l D 41106.« 7 C' 89 ??. , 0-1 rues care - rue NO* Rough-?n Insuecuon Rpqu ned' ?Ready Now E] Will Not l ly, Inspec- ?Yes ?NO for When Ready L- icensed Electrical Contractor I hereby request insoeceon of above ? Owner electrical work installed at: Sl,edt Address. Bo or Route No. City ecuon No. Township Name or No. Range No. Co tv I a t? Occupant (PRINT) Phone No. DO /;J ' G ail G To s ST.A e , ? , Power Supplier Address ECon> , r toe ICOmoany C Llcense No. ontraetttro. i 7-L-11 ' ? Mailing Addres s (Contra for or Owner Making Instailationl / / L S . ?ri07,1 rre .L yl7.J- Author' lure ntm or Ow er Making Installation) Phone Number Ak -aZ & -a s a MINNESOTA STATE BOAR&OP ELECTRICITY THIS INSPECTION REQUEST WILL NOT G,,ggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. ?/?//x? D• 411-06 REQUEST FOR ELECTRICAL INSPECTION II See instructions for comPleting this form on back o1 yollow copy 'X" Below Work Covered by This Request EB-00001-OR 7'?60?9 Ninivf Addl Rep TvPa of Smldmg APPI.Onpes Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtwes Apt Building Dryer Electric Huatui Commercial Bldg. Furnace Silt) llnloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Cher peter v 00w, i5 n?•?rivl i n? SUC[:1 y Oi Cr OthL•r Compote Inspection Fee Below a Fee Service Entrance Size rr Fee FeedersrSubteeders R Fee Circuits 0 to 200 Am s 0 to 30 Amps 0 to 30 Am s Above 200 Amps 37 to 100 Amps 31 to 100 Am s Swimming Pool Above 100_Anq>s Above 100_Amps Transformers IrngaUOn Booms Portia h"Other Fee Signs Special Inspmn rks Q( TOTAL FEE • Rough-,n --• ? C'r 1/q (` r°??d 1, tha ElectnercaI Inspector, heby Final aerti ly that the above inspection has been nnade. This request void 18months from i /? This request void 18 months from ? LC7r C. 7 4 - 2 2 aea ow- !ems ?e $ A, /1-1 I I Request Date Fire No!/ Ro uph-in Ins Vection p. Requ ned? []Ready Now ? Will Notify Inspec `--? ?-o []Yes ?No for When Ready ® Licensed Electrical Contractor - I hereby request inspection of above ? Owner electrical work installed at: Street Address, Box or Route No. City ` >.D /S? TEAS yYE 7-1c, 7-1c, L f1 G/} rJ ecti No. Township Name or No. flange o. County O % FY A-/ r 5 1/ Occupant (PRINTI Phone No. Power Supplier J44i4 C/E?fc.c Address ?Ae T /?N c m/N om Elec lncal Conlr ctor ICompony Name) CpnVacl.r's License No. 4 ??O /E2/?L' T2/G i ?G . Mailing Address (Contractor or Owner Making Installation) a, /GTf>< A,&vu,- & 0D2??EA0, ?i1 Authorize o actor/ ner aking installation) Phone Number y / MINNESOTA STATE BOKftD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Gripes-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1871 University Ave.. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Ph- 19111 9A,-mnn ENCLOSED. ,/i.s/s-2 22 "X" Below Work Covered by This Request C 7 ?`4 -0- E B-00001 55 Add Rep. Tvpe of Building Appliantas Wrretl Equipment Wued Home X Range Temporary Service _ Duplex _ -Water Heater -- - -Lighting Fixtures -°-- Apt. Building Dryer Electric Hearing Commercial Bldg. Furnace Silo Unloader Industrial Bldg. X Air Conditmner Bulk Milk Tank Farm Oter Pei y Other Isprri iy) /`o r/?j`fi t nr ueci ly Other Othr,r?AC? 6 Vlppulc "IJ(ICG Ii UO fee 6e/OW p fee Service Entrance Size a Fee F.edars/Sobf.edars p Fee Cucurts /'r7, yp 0 to 200 Amps Above 200 o mps p /&,Op?j 0 to 30 Amps Z?z 31 to 100 Amps O ? OQ JyP• 0 to 30 Am s 31 to 100 Am Swimming Pool ,7 /?rrn Above 100A00 Amps Above 100_Amps Transtormer5 Irrigation Booms Partial.'Other Fee Signs Special Inspection S Remarks °'7?? OTAL F Rough-in r e _ , p20? the r ns pecl or, hereby Final O r certay that the ahoy. ?spectron has been made. REQUEST FOR ELECTRICAL INSPECTION P See instructions for completing this form on back of yellow copy- tor. re months porn CITY OF EAGAN C 11 l 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 NO 'Ye12 9Ad `t BUILDING PERMIT PHONE: 454-8100 Receipt H 27 To be used for FOUNDATION Est. Value Date DECEMBER 8 ty 86 Site Address 1540 THOMAS LAKE POINTS Erect f Occupancy Lot 4 Block 1 Sec/Sub. THOMAS LK POIN TEmodel ? Zoning Parcel No Repair ? Type of Const . Addition ? No. Stories a Name THOMAS LK HOUSING ASSOC Move ? Length 3 Address 3140 HARBOR LN Demolish ? I I ? Depth F o City PLYMOUWone 559-1711 nt. mpr. Install ? Sq. t. a DOMAIN CONSTRUCTORS INC o Name Approvals Fees i $ ¢ Address SAME Assessment Permit $15.00 City Phone Water 8 Sew. Surcharge Police Plan Review F w Name Fire SAC Address ,a Eng. Water Conn. a w City Phone Planner Water Meter Council Road Unit I hereby acknowledge that l have read this application and state that the Bldg.Off. 12/5/86 Tr. PI. information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan di c APC Parks Var. Date Copies Signature of Permitte" / Total- N CONSTRUCTORS DOMAl INC A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable S of Minn sot 3'Siat? Ltesa(t of an Ordinances. Building Official 60 UNITS- = RENTAL CITY OF EAGAN NO t . '- 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 BUILDING PERMIT - 13070 PHONE: 454-8100 Receipt u k4 O Tobeusedfor APT. BLDG. Est. Value $1,725,000Date DECEMBER 31 986 Site Address 1540 THOMAS LAKE POINTE Erect CY, Occupancy Rl Bl THOMAS LAKE POI Lot 4 Block I Sec/Sub NMEdel ? Zoning PD . Repair ? Type of Const. V 1 HR/IIN SPI Parcel No. Addition ? No. Stories 3 w Name THOMAS LAKE HOUSING ASSOCIAT LOS'e ? Length 377 3140 HARBOR LN Address Demolish ? I l ? Depth 67 S F o City MPLS Phone 559-1711 nt. mpr. Ins all ? q. t 101, 00 ? a I T T T ( Approvals Fees N CONS ORS RUC N o Name DOMA -$Q Address SAME Assessment Permit $ 4,495.5( City Phone Water &Sew. Surcharge 790'0( Police Plan Revlew2,247.7`- ? H Name JOHNSON, SHELDON & Sorensen Fire SAC 28,060:0( ur, Address 10249 YELLOW CIR DR Eng. Water Con4,000.0( <W City MTKA Phone 935-6337 Planner Water Meter N/A Council Road Unit 13,920 0( I hereby acknowledgethat l have read this application and statethatthe Bldg.off. 12/8/86 Tr. PI. 7,625.0( information is correct and agree to comply with all applicable State of ' N/A Minnesota Statutes and C Eagan Ordinan es. APC Parks Var. Date Copies Signature of Permittee Total $81,138 • 2 DOMAIN CONS UCTORS INC A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applica State of Minn sot tut sand C ity of Eagan Ordinances. Building Official ,HEATING TEST RECORD ?? 'C ?? tQ ?t ?;% v °•?" ADDRESS 4Y APTp17?R CI TY?'?- _. SBURB OCCUPANT OWNER ?LLfm(?-LM (:DY U.LX?ItP HEAT LOSS m, ATE TG. INST. JiQ- SOLD BY U? q INSTALLED BY Electrical Work By JG ZL-O-. Goa Line By = 4 TYPE OF HEAT GA -STEAM-SPACE HTR. -UNIT HTR. -OTHER MAKE. Model _ Serial _ INPUT THEIR DESIGN CONVE ION MAKE OF BURNER _ Model Max. BTU Rating MAKE OF FURNACE Model CONTROLS Heat Plug Limit Limit Setting Fan Setting Pilot Type '- Pilot Make Pilot Model Pilot Timing r'?4 L.W. Cut Off l Pressure Percent C02 Input CFH Percent 02 o? Stack Temp. Percent CO to9ln Vent Size KIND OF LI R SIZE r? NONE Draft Hood Regularat Filters Si.. Number Chimney Location IIlnsride 1 Outside Chimney Construction N?G '( ?? Smoke Bomb? c? Wiring b- Draft (/?11d Test Tag t/ Door Pressure Lighting Inst. Date Tested )/? t/-2-7-Y7 Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. ?jnetonk-a.,/UN 5343 ` /.?/ Name of Tester --TlM1U U&a ) / ] E 0 ?,,/y?? ? EATING TEST RECORD ? '?/?,' \J ADDRESS J 2 U.J,I ?-? FLOOR ?' APT. SUBU E}?C.[d?C?.1 -CIj?J ? OCCUPANT / OWNER _ CL , e? / V_ 6 HEAT LO55 tTE T INST - . . 0 a2 64 SOLD BY INSTALLED BY A O ?P.C7 ^411 - Electrical W 4 B O - Gas Line By y TYPE OF HEAT GA -2GFA 4HW - STEAM -SPACE HTR. -UNIT HTR. OTHER - S DESIGN CONV 51 MAKE MAKE OF BURNER Model Model l S i BTU Rating Max a er . INPUT MAKE OF FURNACE Model Valve -A" Limit - Limit Setting Fan Setting Pilot Type S Pilot Make _ ROLS ,t_ ri at Plug Vent Size KIND OF LIN SIZE ¢ NO E Draft Hood / Regulator p? Filters Size I&X'WX I Number I Chimney Location ns'de utsi e Chimney Construction Pilot Model Pilot Timing L.W. Cut Off ?r Pressure Parent COZ Input Percent OZ Stack T Temp emp. _ Percent CO 0 Smoke Bomb Wiring Draft Test T e Door Pressure 07 Lighting Inst. /?-- Q' a 7 Date Tested Company Testing - Rouse Mechanical, Inc. 11348 K-Tel Dr. - Myika 534 Name of Tester /f7t/ ?('?ll / HEATING TEST RE CO J? ADDRESS „v ? h?L? APT./ ? OOR L Cl TY(?_) U?BURB OCCUPANT OWNER ? L5 7 ' HEAT LO Ap? TE H?77G. INST. SOLD BY ? ! PJC _ INSTALLED BY ?? - Electrical Wart By Gas Line By L ,? TYPE OF HEAT GA-?FAsG?IW STEAM SPACE HTR. UNIT HTR. OTHER S DESIGN --MAKE- - - - -- -= MAKE-OF BURNER_ Model a Model Serial - ?- 49104 Max. BTU Rating- INPUT MAKE OF FURNACE CONTROLS THERM A.. _-He Plug valve Limit Limit Setting Fan Setting Pilot Type Pilot Make Pilot Modal Pilot Timing L.W. Cut Off it Pressure Percent C02 Input CFH Percent OZ Stack Temp. Percent CO Model ION L(_ Vent Size KIND OF LI SIZE Draft Hood M . ?" 'gularor Filters Si Siz ze- Number Chimney Location 'da 41 )4 utside Chimney Construction Smoke Bomb Wiring Draft Test Tag Door Pressure ? Lighting Inst. Date Tested 7 //7v - L_77- /a-7r Company Testing -Rouse Mechanical, Inc. r . 77 348 K-Tel D ? W34 Moetqnka e r. Name of Tester H/?lCj7ING TEST RyyyE??'CORD ADDRESS AP T. i( FLOOR C71SUBIJRB_? OCCUPANT OWNER -? d"Y?kQrn-.. ?/S ?•-?/''?_ /1 HEAT LOSS/1 I DAT ?i TG. INST. ,{') SOLD BY ?L INSTALLED BY f?n4L / Electrical W...L By Q Gas Line By VV-b44 /1 l _J_. kjtC TYPE OF HEA/T? GA A HW STEAM SPACE HTR. -UNIT HTR. OTHER J GAS ESIGN COAIV RSION MAKE. Model _ Serial _ INPUT Valve 14-?i Limit Limit Setting Fan Setting _ Pilot Type - Pilot Make - Pilot Model _ MAKE OF BURNER- Model Max. BTU Rating MAKE OF FURNACE Model ROLS ej Plug Vent Size !/_ -r/ J KIND OF LINE _ SIZE _ NONE Draft Hood Regularor Filters Size Z Num•6er / Chimney Location I si,Z?JL Outside ?-? Chimney Construction ?- 1-4211-'l tl // Pilot Timing 1 DLwr ? L.W. Cut Off Pressure /?C ?ct/C Percent COT ?- Input CFH ?^v Percent OZ //yJ?' Stack Temp. Percent CO .--eL7 - Smoke Bomb Wiring Draft Test Tag y Door Pressure Lighting Inst. Date Tested Company Testing - Rouse Mechanical, Inc. 11348 K-Tel Dr. i eto ka, MN 55343 Name of Tester /? HEATING TEST ?RECORD RE ADDRESS' -l"tt / (L J-C l?? L(?fl_00R c-JCL' L' • APT. //CI Y SU URB? OCCUPANT •r - OWNER L Y? ? N,? J?•-.Q HEAT LOSS o A E H G. INST. ? y j SOLD BY INSTALLED BY 0 Electrical Work By 6"0' ? Gos Line By TYPE OF HEAT GA _1.,F- I _-HW STEAM SPACE HTR. -UN IT HTR. -OTHER GAS DESIGN CON' RSION MAKE MAKE OF BURNER Model Model Serial -Z Max. BTU Rating INPUT MAKE OF FURNACE Model THERM?$Tt Valve Limit Limit Setting Fan Setting _ Pilot Type - Pilot Make -4 Pilot Model _ Heat Plug Vent Size KIND OF LI R_ A S SIZE r? NONE ?-? Draft Hood Regulator Filters Si,, Number Chimney Location I sid Outside Lf Chimney Construction Pilot Timing -? L.W. Cut Off C 5'?a Pressure • eJ `(.fle_ Percent CO2 Input CFH I Percent Oy Stack Temp. Percent CO Smoke Bomb Wiring Draft Test Tag / Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K•Tel Dr. inneton MN 55343 Name of Tester 4 „'LJ/r?l l'J(_XlwlO?_? HEATING TEST RECORD 5-t ADDRESS l? APT. FLOOR ITY UBURB OCCUPANT OWNER HEAT LOSS DA E HTG. INST. SOLD BY INSTALLED BY Electrical Wart By Y ?- Gos Line BY p11? TYPE OF HEAT GA --L4'7__HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER S DESIGN CONVERSION MAKE MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT 1 MAKE OF FURNACE Model CONTROLS THERM T T t Plug Vent Sire 7 J Valve KIND OF LIN SIZEONE Limit _ Draft Hood Regularor Limit Setting Filters Size z i Number 11 Fan Setting Chimney Location d Gf side Pilot Type _ Chimney Construction /l Pilot Make alc(7 Pilot Model Smoke Bomb Wiring Pilot Timing Draft 2(? Test Tag L.W. Cut Off Door Pressure r Lighting Inst. Pressure Percent CO, Data Tested Input CFH-<Pereenr 0? O Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO D 11348 KTel Dr. 1 Minnetonka. MN 55343 Name of Tester W-4. /'? H E`,eh(?T/ING TEST ,?RECORD ??I'? ADDRESS /j4C>rzrrn.e APT. LOORCIT?UBU B? OCCUPANT _ OWNER /3Y'WOiM iii/` /n1? / HEAT LOS c? AT TG. INST. SOLD BY INSTALLED BY Q/)IA-Q 0 Electrical Work By ] ? - Gas Line By TYPE OF HEAT GA r/FA HW STEAM-SPACE HTR. -UNIT HTR. -OTHER S DESIGN ERSION MAKE MAKE OF Model M 4, Jr--? Model - Serial Max. BTU INPUT MAKE OF Model THERMO A Valve Limit Limit Setting Fan Setting _ Pilot Type 5 Pilot Make Pilot Model _ CONTROLS iy_ji,/ ?, - Heat Plug Vent Size KIND OF LI R SIZES]-N.QNE Draft Hood Regulator l? Filters Size X( Number CNL _ Chimney Location I i utside Chimney Construction ?L Rte' Pilot Timing C"7 11?? L.W. Cut Off Pressure Percent C02 Input WV Percent OZ Stack Temp. Percent CO Smoke Bomb Wiring C__? Draft Test Tag - Door Pressure /? cLiigghting Inst. Date Tested It n? -)- a , Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Mi netonka, N 5pq 5343 Name of Tester ? /XO.Y.!d?hZ -? BURNER Rating FURNACE l / HEATING TEST RECORD /!1 ADDRESS APT.'/ -F? '?, I ?CIT SUBU OCCUPANT ' OWNER 6ln'nO IM ?1J}L HEAT LOS INST. 7 SOLD BY - INSTALLED BY Electrical Work By w od? 0.- Gas Line By e TYPE OF HEAT GA Zip-HW STEAM SPACE HTR. -UNIT HTR. OTHER GAS DESIGN CON ER ION MAKE MAKE OF BURNER - - Model Model Serial 3 - Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS ? f_y 5 T THERM T Heat Plug Vent Size Valve KIND OF LIN SIZE.- E Limit 7 y Draft Hood R Limit Setting Filters Size Number Fan Setting Chimney Location Ipsi Outside j Pilot Type n Q n S Chimney Construction Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing ? ` pay, Draft Test Tag L.W. Cut Off Lighting Inst Door Pressure {? -7 l f -7:J-?j- 0 Pressure- - Percent CO2 Dote Tested y ?H Input CF- Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp?9nr ? ?T Percent CO 11348 K-Tel Dr. inn tonk MN 55343 Name of Tester dILIX TING TEST RECORD J + ADDRESS OCCUPANT 1540 ? OWNE R LOOR / -CITY - U UR,? HEAT LOSS TE T INST. ??. SOLD BY C INSTALLED BY-4 Electrical Work Gas Line B V/17 r TYPE OF HEAT GA J'G?A -HW -STEAM -SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE - MAKE OF BURNER _ Model Model Serial ' Max. BTU Rating INPUT MAKE OF FURNACE Model ON .r_j•• Vent Size KIND OF LI R _' SI Draft Hood Regularor Filters SizeJ Chimney Location Chimney Construction Pilot Model Smoke Bo Wiring Pilot Timing 0-S Owe, Draft Test Tag ` L.W. Cut Off Door Pressure Lighting Inst. Pressure S'' Percent C02 Date Tested 1o a Input CFHL4C:0 Percent 02 ' IG Company Testing -Rouse Mechanical, Inc. ?Percent CO Stack Temp. f •dl- CLILZ- 11348 K-Tel Dr. 'nnetonk h 55 Name of Tester ? HEATING TEST RECORD // ?/?? \) ADDRESS APT. OCCUPANT/??O 7l OWNER LOOR l p CITA S BUj2B6? HEAT LOSS AT HTG. INST. Z2 / C ??/- SOLD BY ?GIAJP__ 07 INSTALLED BY ..07.C.Q12 _ r.P Electrical Work By Gas Line By tnA k_ .-P TYPE OF HEAT GA CFA t--HW STEAM -SPACE HTR -UNIT HTR. -OTHER AS DESIGN CON E SION MAKE - - - MAKE OF BURNER Model eG Model Serial Max. BTU Rating INPUT ?v MAKE OF FURNACE Model Limi 1, Lmit --FI Limit Setting Fan Setting _ Pilot Type S Pilot Make _ Pilot Model _ Pilot Timing L.W. Cut Off Door Pressure ?r Percent CO2 Input CFFi.a?Percent OZ-? Company Testing -Rouse Mechanical Inc. Stack Temp. Percent CO 11348 KTel Dr. i eto a, M 5 4y{ 3 Name of Tester VI HOL] 4!e- Heat Plug Vent Size KIND OF LINg SIZE'S; NONE Draft Hoed 0_? Regularor 7 Number r Filters Si.. -n ?-? Chimney Location l/,s de side Chimney Construction Smoke Bomb / Wiring Draft ` Test Tag Door Pressure n L?ighting Inst. Date Tested ?r/ -7??° EATING TEST RECORD o t ?? rTYY1 P i- S . ,. - ADDRESS APT: •LOOR CI SUB RB OCCUPANT OWNER {T HEAT LO C? AT ( G. INST. ?U' ? ? SOLD BY INSTALLED BY ??S1 A+0-JL- Electrical Work By - Gas Line By ()A )0-0- ?e C TYPE OF HEAT GA "L--FA ??HW STEAM -SPACE HTR. -UNIT HTR. -OTHER S DESIGN CON / ION MAKE - -- ---- - MAKE OF BURNER Model - Model Serial E274 0F-:2- Max. BTU Rating INPUT MAKE OF FURNACE Model ?- -CONTROLS f ' THERMO TAT Heat Plug Vent Size Valve 1 nt Lij- KIND OF LIN R SIZE NONE Limit Draft Hood Regularor `S_3 ? Limit Setting Filters Size Number Fan Setting Chimney Location side Ou side Pilot Type eL' Chimney Construction S - ph Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing Draft Test Tag L.W. Cut Off V? Door Pressure Lighting Inst. " r Pressure 3-S t?C Percent CO j 7 G ^ Date Tested iD`?L 0 2? 00 Input CFH ' Percent OZ ??o Company Testing -Rouse Mech anical, Inc. -tack Temp. Percent CO CL/, 11348 K-T81 Dr. _ ,Nlinn tonk f / N 55343 ( Name of Tester ? / ? „ ??//// HEATING TEST RECORD ADDRESS J? APT. LOOR L CITY SUBURp "n /6 WNER I?\1r?YYl ll?i.. `? ? OCCUPANT' HEAT LOS D T HTG. INST. SOLD BY INSTALLED BYyy?7T/Tbl/?-1?- t0_Lt Electrical Work By C? Gas Line By CA-v..nom P TYPE OF HEAT GA L-F'A HW STEAM SPACE HTR. UNIT HTR. -OTHER AS DESIGN CO ERS ION MAKE MAKE OF BURNER Model - Model Serial / Max. BTU Rating INPUTSit7/? MAKE OF FURNACE Model ATA THERMO Va lye I re Limit Limit Setting Fan Setting _ Pilot Type Pilot Make Pilot Model _ Pilot Timing cx? + W r- nts Pressure -3.6idL4r Y Percent CO Input CFHp r ? Percent Stock Tem Percent CO O Vent Size KIND OF LIKE R SIZE r5 NONE Draft Hood C-'1 Reguluror Filters Si.. kznb 1 Number Chimney Location Jos rpp e ? Chimney Construction /S sCus Smoke Bomb Wiring Draft ?eY*: Test Tag Door Pressure Lighting Inst. J Date Tested // ? - 9-7 92 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. innetonka MN 55343 Name of Teste r EATING TEST RECORD ADDRESST ila YJ?? 1 r APT:' oOO R/CITY 5113 . .1 OCCUPANT - ? T OWNER (=X%I_rs ?ll[?T 1 /// HEAT LOSS ATE?HTG. INST. SOLD BY INSTALLED BY Electrical Work By e;- gor Gas Line By Q7A/J Q TYPE OF HEAT GA 1~•FA??HW STEAM -SPACE HTR. UNIT HTR. OTHER GAS DESIGN CO VE SION MAKE MAKE OF BURNER- - - - - - Model rC _(7 L Model _ Serial g _ Max. BTU Rating INPUT/? ?t7 MAKE OF FURNACE Model CONTROLS r THERM T T _ Heat Plug Vent Size Valve 11 (1 1jr- KIND OF LI R SIZE NONE -?^ Limit Draft Hood ?\Regulator 3 2 3 Limit Setting Filters Size l Number Fan Setting U cFV f;F Chimney Location 1i Pilot Type n 9 Chimney Construction uC Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timin Draft Test Tag g L.W. Cut Off Door Pressure Lighting Inst. Pressure tr O Percent C02 Data Tested J T , Input CFH Percent 02 Company Testing - Rouse Mechanical, Inc. Stack Temp. Percent CO v 'u 11348 K-Tel Dr. MN 55343 Minnetonka, Name of Tester & urXiii-r- ( ffy[THOAI / 1r [?/ `j''--/In HEATING TEST RECORD 4y ADDRESS t' /? 1 t' `L?YY??.C? L ??! ?? • APT. OOR It% CI?o SU URIB OCCUPANT OWNER (?Oyl HEAT LOS SATE HTG. INST. SOLD BY INSTALLED BY ?' ^ Ol/,d-2 Electrical Work By P QC ? Gas Line By UN? i TYPE OF HEAT GA __]cF7C HW STEAM SPACE HTR. UNIT HTR. -OTHER AS DESIGN MAKE MAKE OF BURNER_ Model Model Serial h0q- _ ZZ& Max. BTU Rot,ng- INPUT MAKE OF FURNACE Model CONTROLS tf ,/ THERM T T . Heat Plug Et Vent Size , Valve KIND OF L1 R SIZE NONE _ Limit Draft Hood Regularor °&;-S"' 5 Limit Setting Filters Size Number ' Fan Setting ?ide Chimney Location rf's I 1 Outside y Pilot Type ' m; Eg Chimney Construction Qn Pilot Make Pilot Model v / \1 J`7 Pilot Timing - L.W. Cut Off Pressure /t Percent CO2 Input CFHH 'OWPercent Oz Stack Temp. Percent CO ??? Smoke Bomb Wiring Draft Test Tag- (J Door Pressure G-f Lighting Inst. Date Tested ?W Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. A9innetonka N 55343 Name of Tester h?/f[dr?.(' / 6ftZZ.::) H TING TEST RECORD ADDRESS APT.1I OR CITY ?-SUBURFj. _ OCCUPANT OWNERS-/n'` C.:CIY(` / -S- HEAT LOSS AT HTG. INST. SOLD BY INSTALLED BY r Electrical Work B I.LCL1-,f Q,(e^ Gas Line By TYPE OF HEAT GA ?/ HW STEAM -SPACE HTR. UNIT HTR. OTHER AS DESGN MAKE JOTIC 4 MAKE OF BURNER_ Model Model Z-7 Max. BTU Rating - INPUT MAKE OF FURNACE Model ?? ONTROL5 THERMO T Heat Plug Vent Size Valve SIZE NONE KIND OF LIN odaAT ' L ' Draft Hood Regulator ` ? Limit Setting Filters Size Number f Fan Setting Chimney Location ;?ngide udo Pilot Type Chimney Construction Pilot Make d Pilot Model S P-7/ S7A' Smoke Bomb Wiring 'y Pilot Timing a- Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. R Pressure Percent C0 ?LL?' ?? Date Tested /?-z ?? t+ Input CF ? 2 Percent O2 ?? ???? Company Testing -Rouse Mechanical Inc. Stack Temp. Percent CO 11348 K-Tel Dr. Wj 55343 Name of Tester k (EXA,, EATING TEST R/ECORD r ADDRESS 640 t y/???'Q APTI.I F'yp\O,_R _I, ? CITY SUBU B._(..?SSL?B?/ OCCUPANT OWNER '?!^^ QZ - r HEAT LOSS ,,,?A/TE H/AI? INST. 1;?J ?d-P SOLD BY VC17X't- XJ .. INSTALLED BY 1t M "10 Electrical Work By JLw Gas Line By Wow LO 4 1, TYPE OF HEAT GA _7_1FA ??HW STEAM SPACE HTR. UNIT HTR. OTHER S DESIGN MAKE I -MAKE OF Model LqjC-A Model - $erial / !' - F29 X / ) Mo.. BTU INPUT MAKE OF Model THERM TA Valve Limit Limit Setting Fan Setting _ Pilot Type . Pilot Make - Pilot Model _ BURNER- Rating FURNACE JTROLS Heat Plug Vent Size KIND OF LI R SIZE ?NONE Draft Hood 0Y_\ Regularor Filters Size Number Chimney Location nsida 0 ts?ide Chimney Construction C _ Pilot Timing L.W. Cut Off Pressure ,y Percent CO2 Input Percent 02 (, --E+i-- Stack Temp Percent CO t? Smoke Bomb Wiring Draft a?Test Tag Door Pressure I ?) Lighting Inst. Date Tested !U-?° Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Min- - netonka, N 55Jy1 343 l/•CgC{.C,Qd__)t.¢?r?-? Name of Tester /f?/Li1(,•Te_L<?/7 HEATING W TEST RECORD 5} ADDRESS ?? N r /?+Q , A APT. OOR I -C RB OCCUPANT OWN:RMM - C2.1i>, HEAT LOSS AT HTG. INST. d' Y7 SOLD BY INSTALLED BY Electrical Work By X-0,076, 0-f F-jo p-e - Gas x TYPE OF HEAT GA -1CFA HW STEAM SPACE HTR. UN IT HTR. OTHER G.AS DESIGN MAKE MAKE Model Model Serial Max. INPUT MAKE CONTROLS THERM T T t Heat Pit Valve Limit C Limit Setting Fan Settin Pilot Type _ Pilot Make Pilot Model Pilot Timing L.W. Cut Off Pressure .PercentC02 5% Input CFH Percent OZ l? Stack Temp. Percent CO 070 OF BURNER BTU Rating OF FURNACE Model Vent Size KIND OF LI R SIZE NONE Draft Hood ? C210 Regulator 2 Filters Size Number Chimney Location Outside ?J Chimney Construction Ir(c Smoke 8om Wiring L___? Draft Test Tag Door Pressure Lighting Inst. / Date Tested J ? c Q `Z? R:2 Company Testing -Rouse Mechanical, Inc 11348 K-Tel Dr. inneto/n?ka_, MN 55343 Name of Tester ? ((?l(??l (d.YlL/?/ Gr.}.-? ,? /I,, [/J?1HEATING TEST RECORD ADDRESS ' /11 (?C.7?-C-r L.' AP LOOR CI OCCUPANT OWNER (r HEAT LOSS D TE TG. INST. -?//? 14 SOLD BY _ INSTALLED BY,I is , Electrical Work By Q0 Q4 - Gas Lina 8y ?C(, - TYPE OF HEAT GA ?P7r ??Hw STEAM SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CON ER ION MAKE MAKE OF BURNER Model 0 Model Serial „? 821 Max. BTU Rating INPUT ?5t?? MAKE OF FURNACE Model rnNTROLS Valve Limit Limit Setting Fan Setting _ Pilot Type { Pilot Make _ Pilot Model _ Heat Plug Vent Size rl _ !/ KIND OF LI R_ SIZE ! NONE Draft Hood Regulator Filters Size Number ! Chimney Location Insid Outside t__? Chimney Construction Pilot Timing C_7--a-r4-_ ' L.W. Cut Off Pressure Percent C02 Input CFH Percent OZ Stock To mp. Percent CO Smoke Bomb Wiring Draft L "5177 Test Tag Door Pressure Lighting Inst. Date Tested /O Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. inn MN 55343 Name of Tester _4 HEATING TEST RECORD dq"l ADDRESS APT. OCCUPANT '??? OWNER LOO Y ?S BJ,IRRB10i _ HEAT LOSS' DA?T`p H'TG. INST. SOLD BYn I M l[-INSTALLED BY Electrical Work By U& kk" Gas Line By O/LQ 4 TYPE OF HEAT GA LTA ? STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE -- MAKE OF BURNER_ Model Model Serial ?- Z?Q9 Max. BTU Rating - INPUT MAKE OF FURNACE Model CONTROLS trJ?y THERM T T Heat Plug Vent Size Valve KIND OF LI R SIZE NONE- Limit - Draft Hood Regularor 'I tAX Limit Setting Filters Size Number Fan Setting d Chimney Location Inside tside Pilot Type Chimney Construction 61 Pilot Make 14 Pilot Model S^ 7?' Smoke Bomb Wiring Pilot Timing ri Draft a Test Tag L.W. Cut Off CC ?? Door Pressure pry Lighting last Pressure •J?? Percent CO270 Date Tested 'l Inpur CFH Percenr 02 a Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO /a 11348 K-T81 Dr. n/?etonka, MN 55343 Name of Tester on 'f./..c 7X?CXO ERy / EATING TEST RECORD ADDRESS APT. 170 1'c1T !OO_R_/ C}?Y- BUURB OCCUPANT OWNER I..UIY1nAM 1-?JYt 1'f71?C"?7, HEAT LOSS DAT HTG. INST. SOLD BY Z - INSTALLED BY ??- Electrical Work By 1 A ,? IL!°^ Gos Line By A ^ TYPE OF HEAT GA -1.CFA rw?HW STEAM SPACE HTR. UNIT HTR. OTHER If AS DESIGN COI VE SION 40 0 MAKE- v -- MAKE OF BURNER - - Model P69 P - 7 Model Seriol r?C Maz. BTU Rating. INPUT MAKE OF FURNACE Model - CONTROLS THERMO T Heat Plug Valve Limit Limit Setting Fan Setting r Pilot Type Pilot Make /I Cf Vent Size KIND OF LI R afil Draft Hood Filters Size Chimney Location Ir Chimney Construction ___? SIZE 62'" NONE Pilot Model f Smoke Bomb Pilot Timing Draft L.W. Cut Off Door Pressure Pressure lJ Percent C02 Date Tested Input CFH 731 Percent 02 D Company Test Sto ek Temp. Percent CD Wiring Test Tag-. Lighting Inst ng -Rouse Mechanical, Inc. 11348 K-Tel Or Minnetonka, MN 55343 Nome of Tester 7V ADDRESS- 1?7V IYYY,71? / [/ Z.Q_ EATING TEST RECORD t-6, P _APT&QE OOR2 CI SUB RB OCCUPANT OWNER HEAT LOSS D TE TG. INST. SOLD BY , INSTALLED BY Electrical Work By V-0 A - Gas Line By /94.n 0 (1 ^ TYPE OF HEAT GA __GFX_ HW - STEAM SPACE HTR. -UNIT HT-R. -OTHER GAS DESIGN CONVE SION MAKE - - - -- MAKE OF BURNER Modsl k 6j ) p% - 1 7,p Model Serial -'17 7, 3 Ma:. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS /r THERMO AT C1 _. Heat Plug Vent Size Valve KIND OF LIN _ SIZE NONE Limit - Draft Hood Regularor Limit Setting - Filters Size Number Fan Setting Chimney Location 1 i e- Outside Pilot Type _ 0 Chimney Construction .a 0?1 nS Pilot Make Pilot Model Smoke Bomb Wiring v Pilot Timing Draft ?A Test Tag L.W. Cut Off Door Pressure Lighting Inst. / Pressure / - 10 / -?y '?? ,1JC Percent CO 2 X Date Tested ?O 7 7 69p Company Testing -Rouse Mechan ical, Inc. Stock Temp. Percent CO O In 11348 K-Tel Dr. Min?nka, A I? N 55343 r^- ?[ <( Name of Tester n/ HEATING TEST n RECORD ADDRESS AP:O 00 _ CIp $UBU B OCCUPANT OWNER f-T?"Yt??'? L! HEAT LOSS ATE TG. INST. -F5' ._? SOLD BY JA fA INSTALLED BY P 1P? Electrical Work By - Gas Line By POW D ad; U,(l ? TYPE OF HEAT GA _ FA ( H -STEAM SPACE HTR. UNIT HTR. OTHER 0 GAS DE IGN C ERSION MAKE MAKE OF BURNER Model Model Serial ?3 g '??YlJ Max. BTU Rating INPUT MAKE OF FURNACE CONTROLS Model THERMO AT I T? ,_?k{p at plug Vent Size -( Valve J KIND OF LIN M_ SIZE 42 ?t NONE Limit Draft Hood /10 4'L Regulator ?- Limit Setting I Filters Size IIY Number - Fan Setting Chimney Location In ide Outside e Pilot Type /t - Chimney Construction 5w) b, Pilot Make Pilot Model - Smoke Bomb/ Wiring Pilot Timing e ^S 4e L Draft Test Tog L.W. Cut Off Door Pressure Lighting Inst. Pressure 3'??^^t?M fy?-?+ Percent C02 020 Dote Tested ?N _7-7 ?' Input CFH?h%Percent 02 0 • 5' IQ Company Testing -Rouse Mechanical, Inc. Stack Temp. =??-?iF?mi Percent CO 11348 KTel Dr. innetonkA MN 553 43 Name of Tester HEATING TEST RECORD ADDRESS /?71/ (IYYYj"? /fy ?(.? AP TC25f L 00R ITY SUBURB OCCUPANT OWNER ll3'1 (m?- HEAT LOSS r DA E HTG. INST. SOLD BY `Pr - INSTALLED By?K 11 _. Electrical Work By P - Gas Line By l COr " TYPE OF HEAT GA vfA HW -STEAM SPACE HTR. -UNIT HTR. -OTHER GA\S DESIGN CON E ION MAKE - - - MAKE OF BURNER =- - Model Serial LV Model I _ - Max. BTU Rating INPUT MAKE OF FURNACE Model THERM T T V ' Heat Plug Valve I Limit Limit Setting _ Fan Setting _ Pilot Type Pa 4&_-4aw Pilot Make R5 ff --s Pilot Model l Pilot Timing - ^ L.W. Cut Off Vent Size Pressure --t'?-?- Percent COZ Input CFH Percent Stuck Temp. Percent CO ?L? KIND OF L Draft Hood _ba- Filters Size Chimney Location Chimney Construction Regularor E Smoke Bomb Wiring Draft Test Tag Door Pressure Lighting Inst. Date Tested ?f Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. net nka, 5 343 Name of Tester tt HEATING TEST RECORD 4A ADDRESS APT O Tj?SUBU BL?4J OCCUPANT OWNER HEAT LO)t, DAjE HTG. INST. - SOLD BY ?'(%ta.-o???GG? INSTALLED BY ?'^ ? APP Electrical Work By Gos Line By ,=y?.,Q_- AO A' _ TYPE OF HEAT GA FA HW STEAM -SPACE HTR. -UNIT HTR. OTHER .GABS DESIGN CONV ON 0 0_/ ?J - - - MAKE OF-BURNER = - - - - MAKE Model - PY! Model Serial tw' 4- 7 Max. BTU Rating INPUT. 45,400 MAKE OF FURNACE Model THERM T T Heat Plug Vent Size Valve (.?"'t - KIND OF LIAR SIZE NONE Limit M7w yIf Draft Hood Regulator ?Z-?--S Limit Setting Filters Si.._)J?A ZOX I Number Fan Setting Chimney Location side Outs.4 ?f Pilot Type Chimney Construction e /T/ /- IFS S Pilot Make Pilot Model 5_rV7/ 3W- Smoke Bomb -? Wiring Pilot Timing Draft Test Tog L.W. Cut Off 6210 Door Pressure Lighting In Pressure st. Percent C02 Date Tested 'Z-7- ` a ^G Input CFHL-Percent OZ d Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO U 11348 K-Tel Dr. Minn tonka, M 5343 Name of Tester j1'0? ADDRESS /6q0 IYY HEATING TEST RECORD APT OOR 4 ?2 CI SUB R11 _ OCCUPANT OWNER !D//f. HEAT LOSS TE TG. INST. t n/ ? 9 SOLD BY INSTALLED BY /nA ?? D 1 Electrical Work By Gos Line ey (l7A LI 0 TYPE OF HEAT GA -4-,PA HW -STEAM SPACE HTR. UNIT HTR. OTHER AS DESIGN MAKE-- - - - MAKE OF BURNER. Model - Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model ONTROLS T ?- s !f - THERM T T Heat Plug _ Vent Size Valve KIND OF L SIZE NONE -~ Limit Draft Hood M Regulator Z -? Limit Setting Filters Size Number Fan Setting Chimney Location I zi a Out de Pilot Type Chimney Construction s Pile, Make Pilot Model 5 Smoke Bomb Wiring Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure-ercent COZ Dote Tested '/ Input CFH Percent OZ f? Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 K-Tel Dr. Minnetonka. MN 55343 Name of Tester '_-1 f J_tkof I ZZICZ -A ///) Oo ADDRESS /?lD ?l? ATING TEST RECORD APTC''?X??FIL R CITY UBU OCCUPANT OWNER HEAT LOSW DL TE?}I TG. INST. l17d-44 _ c SOLD BY ? _ INSTALLED BY _ Electrical Work By A?OA - Pte= Gas Line 8y TYPE OF HEAT GA HW STEAM SPACE HTR. - UNIT HTR. _____OTHER AS DESIGN MAKE - - MAKE OF BURNER _ Model Model Serial l _ - 7 Max. BTU Rating _ INPUT MAKE OF FURNACE Model I.VIVIKVLD 4Lt! i? THERMO AT Heat Plug Vent Size Valve KIND OF LI R SIZE J NONE 5- gg' Draft Hood hud't on Regulator Limit I J& Limit Setting Filters Size X7l2'e) Number Fan Setting Chimney Location u, id. Pilot Type -ate. Chimney Construction C KaL7Cr+->~?'? Pilot Make d Pilot Model I Smoke Bomb Wiring Pilot Timing Draft Test Tag-? L.W. Cut Off Door Pressure Lighting Inst. Pressure 3.5"(4-C- Percent C02 Date Tested L`J-7 input CFH 4Si Percent OZ Q'22 - Company Testing -Rouse Mechanical, Inc. Staek Tsmp. Percent CO 11348 K-Tel Dr. Minnet nka N 55343 Name of Tester J Q?? HEATING TEST RECORD ADDRESS 1 PD APT.PQ1 OOR?2 L9_1 1 l ?l C Y _ OCCUPANT OWNER HEAT LOSS tTE TG. INST. Y=KZ SOLD BY INSTALLED BY Electrical Work By X, - Gas Line 8y J9AIA TYPE OF HEAT GA -LC??_HW -STEAM SPACE HTR. -UNIT HTR. OTHER S DESIGN MAKE - - MAKE OF Model - y Model Serial ?11 2 Max. BTU INPUT 'tea/ MAKE OF Model THERMO A 1011 Heat Plug Valve Limit Limit Setting Fan Setting Pilot Type Pilot Make Pilot Model 4 :2 Pilot n- L.W. Cut Off Percent CO2 Pressure Input CFH Percent 02 Stack Temp. - Percent CO BURNER- - Rating FURNACE R JCi. Vent Size KIND OF LI R SI Draft Hood !- Regulator Filters Size ?U//yy `_ZX t Number Chimney Location n ida Chimney Construction C/ Smoke Bomb Wiring Draft Test Tag Door Pressure Lighting Inst. Date Tested 10-Q -7-R2 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. inneto/ ,MN 55343 Name of Tester _( nzC ? EATING TEST RECORD ADDRESS AP T.. OM6 LOORC OCCUPANT OWNER HEAT SOLD BOSSD/yT?HC„ INST. - - INSTALLED BY Electrical Work By A -??A19A Gas Line By TYPE OF HEAT GA ?ct~I(? STEAM SPACE HTR. -UNIT HTR. GAS DESIGN MAKE MAKE OF BURNER _ Model -' - Model Serial BTU Rating INPUT MAKE OF FURNACE Model OTHER VK IKUL? ? -// r ' THERMO A Heo Plug Vent Size _ Valvs KIND OF LIN SIZ N E _ 9? 1 oil (I low Limit Draft Hood _ K? Regularor Limit Setting Filters Si.. Number Fan Setting Chimney Location Inzi Outside Pilot Ty pa Chimney Construction H / as r Pilot Make i-? Pilot Model Smoke Bomb-* Wiring Pilot Timin Draft C Test Tag g - L.W. Cut Off r Door Pressure Lighting Inst. Pressure / Percent C0 Data Tested ?V-/ 2 Input CFH Percent OZ Company Testing -Rouse Mechan ical, Inc. ° Stock Temp. Percent CO 11348 K-Tel Dr. CONV Minneton f MN 55343 Name of Tester' HEATING TEST RECORD ADDRESS /? /?? t /1/ d? //•?•??- ??' APT OO?R CITY SUBI19 OCCUPANT OWNER 1 -t7-YrtCLC?-? h1r1C 7tC4LV-7 HEAT LOSS DAT TG. INST. SOLD BY INSTALLED BY - - Electrical Work By EPA) r_uZ "-= Gos Line By /nnn a -06A 11, . TYPE OF HEAT GA CFA W STEAM -SPACE HTR. UNIT HTR. OTHER CONY SIGN MAKE OF BURNER - - MAKE &ktzm?5??Mod.l Model Serial Max. BTU Rating INPUT 45/60D MAKE OF FURNACE Model CONTROLS THERM STAT - F at Plug Vent Size Valve'? 5 t?(? KIND OF LI R SIZE NONE 1426 Lt Draft Hood Regularor -? -3 Limit Setting Filters Size' _M Number Fan Setting Chimney Location da?J?r/L?'Lr)Outside Pilot Type ?-?- Chimney Construction Jn?si?S S Pilot Make Pilot Model Smoke Bomb Wiring I--- ti Pilot Timings Draft Test Tog L.W. Cut Off -? Door Pressure « Lighting Inst. Pressure `:: S?tf f Percent CO2 ?0 Date Tested 8?? Input CFH 45660 Percent O2 Company Testing -Rouse Mechanical, Inc Stock Temp. 09% Percent CO 11348 KTel Dr. 3 Minnetonka, N 5534/3/] 0(/ f ?± Name of Tester t t'r/dxa-+?? HEATING TEST RECORD ? 7??u', ,sI?ro, ,,' 1/ '? ? ADDRESS APLFL R Y SCI BURB.ld?1?'t^-? OCCUPANT OWNER (%daa OSS 9ATE HEAT F[?5Ct. INST. &. 4 114t SOLD B ^ INSTALLED BY Electrical Work By Q ?- Gas Line By TYPE OF HEAT GA - L??4 HW STEAM SPACE HTR. -UNIT HT-R. OTHER GAS DESIGN CONY R /ON MAKE - - - MAKE OF BURNER- - - - - Model 6 . - Model _ Serial - $ Max. BTU Rating INPUT etb MAKE OF FURNACE Model CONTROLS ? r- THERM T T Heat Plug Vent Size Valye I _ KIND OF LIN _R SIZE J .l NONE Limit Dra{} Hood m' rte Regulator i- Z 3 Limit Setting / Filters Site MXZUX / Number - / Fan Setting Chimney Location Ins a ??Outside Pilot Type Chimney Construction Pilot Make . Pilot Model < ? Smoke Bomb Wiring Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure ' S ""41 .tA Percent CO '7 CLt Date Tested I? -Z?' 0 p / ? 2 / Input CFH ¢5/0426 Percent OZ_[ / w7 CLC? Company Testing -Rouse Mechanical, Inc. Stack Temp. ?gs? Percent CO 196 11348 KTel Dr. Minne MN 55 43 a Name of Tester )ss????// y" ? ADDRESS I?/7O J / ?, /may [le,, t?fIYYY,IO ((M?-- XATING TEST RECORD APT OOR \J < CITY SUBIJRB*A OCCUPANT OWNER CYi M 1, J? S HEAT LOS DATrE HTG. INST. SOLD BY `p ?Y? INSTALLED BY 'P Electrical Work By PP- Gas Line By -Q `PP?. TYPE OF HEAT GA 'FA HW STEAM SPACE HTR. -UNIT HTR. OTHER GAS DESIGN MAKE - - MAKE OF BURNER- Model - Model Seriol 1 _ F Z?Z Max. BTU Rating - INPUT ;M160 ) MAKE OF FURNACE THERM WA Valve Limit Limit Setting Fan Setting _ Pilot Type s Pilot Make Pilot Model _ Pilot Timing L.W. Cut Off Heat Plug Pressure Percent COZ? Input CFH Percent OZ Stack Temp. Percent CO Model v u _5 r. Vent Size KIND OF LI R 694*75 SIZE err NONE Draft Hood Regalator 3zs Filters Size 7 Number Chimney Location ?Ingi de utside Chimney Construction Smoke Bomb __- Draft r -/ Wiring Test Tag Door Pressure -? Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. innetonk MN N 55343 / Name of Tester J ( HEATING TEST RECORD ?f ?? /J? l`/(; t tw7na (/I D ? . o . ADDRESS AP7 T T5?7?R?R " OCCUPANT S / OWNER HEAT LOSS ATE HTG. INST. SOLD BY - INSTALLED BY - Electrical Work By - Gas Line By Kit-uLP . M?.Ii TYPE OF HEAT GA __IGfA _Lf!f?HW -STEAM SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN C VERSION MAKE MAKE OF BURNER _ Model ELI - Model Serial - Max. BTU Rating INPUT 451X20 MAKE OF FURNACE Model CONTROLS /r THERM%T T Heat Plug Vent Sire Valve KIND OF LI R SIZE_ci"' NONE ?- ' Limit Z-5 -? Draft Hood Regularor r ??+ Limit Setting r Filters Size Number ! Fan Setting - Chimney Location ?Insi [G Outside Pilot Type /L Chimne Construction IMr L r7?S y Pilot Make Pilo, Model Smoke Bomb Wiring y- Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure 1(0 J(7 Percent CO Date Tested /t Z Input CFH?Percent OZ , Company Testing -Rouse Mechanical, Inc. 71D Stack Temp. - Percent CO 17 11348 K-Tel Dr. /Minnetonka, MN 55343 4 Name of Tester d'i .?? ?j W1 HEATING TEST RECORD ??y1 ADDRESS lv,y//JJ..//,? ?1'Y[.Q AP 1_?_ OORv CI T)Y 5}J?BU?RB OCCUPANT -?7 OWNER &r) 1IY1/('oy toys HEAT LOSS D TE G. INST. gnl SOLD BY lPA' INSTALLED BY P-0-14 S Electrical Work By y Gas Line By (17.1/10 TYPE OF HEAT GA i FA ? HW ` STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE MAKE OF-BURNER_ Model - F/e^ Model Serial ????' FZoY7- 2774 Maz. BTU Rating- INPUT . 5 MAKE OF FURNACE CONTROLS THERM T T Heat Plug Valve Limit UtTYUJ4 I'm Limit Setting ql)` Fan Setting 1, Q Pilot Typa Pilot Make Pilot Model S Pi /• Pilot Timing L.W. Cut Off Model Vent Size KIND OF LIN R SIZES r_ NONE Draft Hood Regularor Filters Size 1(4'7nX I Number Chimney Location n ode D raids Chimney Construction lz Pressure Percent C02 Input CFH ?? Percent OZ Stack Temp. Percent CO Smoke Bomb Wiring / Draft Kw ` 19Test Tag Door Pressure ? Lighting Inst. Date Tested lo - Z7-7-?? Company Testing -Rouse Mechanical, Inc 11348 KTel Dr. Mi nn MIN 55343 ettonkka /g7/ in p "A __ i Name of Tester ' ?- L. r ? `' HEATING TEST RECORD lJ B ADDRESN 16 T_AC`y)9&4Z ?? Pt- OWNER?LOOR_CJ?( {-L? HEAT LOSS AT ?i1 HTG. INST. SOLD BYrrri? - INSTALLED BY.???LhQ-?. f Thu ii_ i _TT ri i Electrical Work Byr OA/ Cift OA ?:C Y X Gas Line By TYPE OF HEAT GA L!FA vHW STEAM -SPACE HTR. UNIT HTR. OTHER - S DESIGN ON /ERSION MAKE - MAKE OFBURNER _ Model `04e Model Serial ?? - - P-20e?'7 - 9-Z75 Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS THERM TAT 1) Heat Plug tt 1?.? Vent Size Va lre n?P-? KIND OF LINEI SIZE NONE Limit Hniwa f Draft Hood V Regulator Limit Setting /?JD_F Filters Size Number / Fan Setting de Chimney Location Pilot Type Chimney Construction ? ANT Pilot Make a-?- Pilot Model - ?1 Smoke Bomb Wiring T Pilot Timing Draft est Tog L.W. Cut Off rl Door Pressure Lighting Inst. / Pressure _3-;5!1410- Percent CO Date Tested /U .- Z7-77 2 Input CFH Percent 0 Company Testing -Rouse Mechanical, Inc. 2 Stack Temp. !? Percent COO 11348 K•Tel Dr. Minnetonka, MN 55343 Name of Tester HEATING TEST R EECORD ' n ADDRESS `'fil l ' y?J / / ?• APT I? r4'OOCITY S BURB ? OCCUPANT OWNER I-.r? t/ 1<!/Lrt ?.Ol1S .c 5 HEAT LOSnS DgAT E HTG. INST. ? SOLD BY-/-?_ INSTALLED gY //??VJ /A LI 0 fP.1? ) Electrical Work By - ? Gas Line By TYPE OF HEAT GA V A4H STEAM SPACE HTR. UNIT HTR. -OTHER GAS DESIGN CO VERSION MAKE MAKE OF BURNER _ Model Model _ Serial 3) - Z2Z Max. BTU Rating INPUT O MAKE OF FURNACE Model CONTROLS _ THERM T T Heat Plug Vent Size Valve KIND OF 1_14J?R SIZE S r? NONE Limit Draft Hood Regulator Limit Setting Filters Size ??X wx Numbers Fan Setting Chimney Location {bside utside f Pilot Type ( Chimney Construction Pilot Make Pilot Model P'7 I SR Smoke Bom b Wiring L? Pilot Timing ? ? - / ? Draft &V-Test Tag - L.W. Cut Off Door Pressure Lighting Inst. !., Pressure a Percent CO2 -1 Date Tested /o - s/ Input CFH 5/0 Percent 02 Company Testing -Rouse Mechanical, Inc. J Stack Temp Percent CO 11348 K•Tel Dr Minn ton ka, M N 553 43 nk A 34 Name of Tester HEATING TEST RECORD ADDRESS X540 ! /tdYY.C7lJ (. P2 - AP TQ1..?F?L?OO?R?ST/? SUBU B1v OCCUPANT _ OWNER 1.177/LC(.IM (_Y7y"LC HEAT LOSS D`ASpE HTG. INST. SOLD BY 4?-"1+' - INSTALLED BY/? Electrical Work By ? - Gas Line By TYPE OF HEAT GA _J_?A J?HW STEAM-SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CON E SION MAKE MAKE OF BURNER Model O Model Serial c' 3M00- 55Max. BTU Rating INPUT (an MAKE OF FURNACE Model Valve Limit Limit Setting Fan Setting _ Pilot Type Pilot Make _ Heat Plug Vent S?:e f KIND OF LI R ' r11 SIZE_,? NONE Draft Hood Regularor Filters Si.. ?oXZOXI Number - Chimney Location I si a?TOutside Chimney Construction Pilot Model Pilot Timing L.W. Cut Off -?I? y.? Pressure 5 ?r(/l._ Percent CO2 Input CFH AQP4 Percent OZ .SQ0 Stack Temp. Percent CO ?J ?? Smoke Bomb Wiring Draft (J Test Tag Door Pressure Lighting Inst. kU - 7 6-N- ? Date Tested - Company Testing - Rouse Mechanical, Inc. 11348 KTel Dr. L Vinnefonks, 55343 Name of Tester Iv/?T H TING TEST RECO RD ADDRESS I-?+V?YVJCI,? I.I.CACL ?• APTOOR? CITyM-? SUB RB e?j OCCUPANT OWNER (I`(VYl ??.-? u7Yl.?I? HEAT O55??J?DAT? )TG. INST. n SOLD B BY INSTALLED BY) Ik?? Electrical Work By O It AO( O/a _ Gas Line By FVAJn TYPE OF HEAT GA CFA _ IW STEAM -SPACE HTR. UNIT HTR. -OTHER GAS DESIGN CO E SION MAKE MAKE OF BURNER Model qq Model Serial I?DAJ,3 - _ Y Max. BTU Rating 14 INPUT MAKE OF FURNACE Model CONTROLS THER T T Heat Plug Vent Size f-5 Valve KIND OF L ER_ IZE _ N E Limit Draft Hood Regulator ZJ Limit Setting Filters Size Number Fan Setting Chimney Location sid Outside Pilot Type Chimney Construction Pilot Make Pilot / ot Model l Smoke Bomb _ Wiring -? Pilot Timing Draft Test Tag L.W. Cut Off y? Door Pressure ?I? •7 ?+?? Lighting Inst. Pressure '• Zrrj Pe rcercent CO 2 s , Date Tested /V L?- O Input CFH //ax??s^??)?L) -Pent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 KTel Dr. AAjnnetonka _1 55343 ? Name of Tester /"/ TING TEST RE ORD ADDRESS ' , tI ?YY)a,Q 40 APT LOOR -Y ?5 BUR OCCUPANT OWNER O?Y20/irt. (/nom A HEAT LO$ ATE TG. INST. - /,/7 SOLD BY INSTALLED BY .' I.ae- ?P Electrical Work By Gas Line TYPE OF HEAT GA fiFA _HW STEAM -SPACE HTR. UNIT HTR. -OTHER LO OZ?M -) GAS DESIGN MAKE MAKE OF BURNER _ - Model va ?r -o -A -ne Model Serial Max. BTU Rating - INPUT MAKE OF FURNACE THERMPfTj _hLa Va l r? Limit Limit Setting Fan Setting _ Pilot Type - Pilot Make - Pilot Model _ Pilot Timing Heat Plug L.W. Cut Off Door 157) - Pressure S Percent CO2? Data Pressure Lighting Inst. Tested O Input CFHPer<ent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 K-Tel Dr. nneton 14 ?'W/l Name of Tester e Model Vent Size KIND OF LIN Draft Hood Filters Size Chimney Location [?n?9 Chimney Construction -L ide Smoke Bomb ? Wiring - Draft /59-9224)- Test Tag q( J?Z HEATING TEST RECORD ADDRESS l5-/D ? APT.7??, am) OOR TY UBURBLC,, ?y ,, l/ OCCUPANT OWNE_ y f"Q7'YIC)...-, ?l?J)TS HEAT LOS ?? / AT HTG. INST. SOLD BY (e_ INSTALLED BY Electrical Work By exslrl '711-40 - Gas Line By tCd)La 0.t?j TYPE OF HEAT, GA _?A -HW STEAM -SPACE HTR. UNIT HTR. -OTHER MAKE Model _ Soria I . INPUT ERM(}?Tq Va Valve Limit Limit Setting Fan Setting _ Pilot Type s Pilot Make . DESIGN 0 ERSION MAKE OF BURNER Model _ yZ Max. BTU Rating MAKE OF FURNACE Model CONTROLS - Heat Plug Pilot Model =2Y 1'62 Er Pilot Timing L.W. Cut Off Pressure •? o° Percent CO2 D Input CFH Percent 02 Stack Temp. Percent CO - Vent Size KIND OF LIN R SIZE NONEZ ,tM .tj Draft Hood Regulator 752:S_ __-3 Filters Size Number Chimney Location ode O is 'de Chimney Construction Smoke Bomb Wiring !_-? Draft Test Tag l? Door Pressure •7 Lighting Inst. Date Tested 10 -76 -F? Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. ??/'7Minnetonka, MN 55343 Name of Tester tmA&V. = OH ATING TEST RECORD ADDRESS APT OOR?( OCCUPANT OWNER HEAT LOSDAT HT/G. INST. SOLD BY INSTALLED - Electrical Work By 40-'f Gas Line By TYPE OF HEAT GA FA HW -STEAM SPACE HTR. UNIT HTR. SUBU OTHER GAS DESIGN MAKE MAKE OF BURNER _ Model g Model n" QT- - Serial Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS -? THERM T T _ Heat Plug Valve Limit Limit Setting Fan Setting _ Pilot Type n Pilot Make Pilot Model 7 Pilot Timing L.W. Cut Off Pressure Percent COZ_ /O Input Temp. Percent OZJf! Stack TemLLLG LLss ?!lJJ?? Gt -Percent CO /L f/ Vent Size I 7_6 KIND OF LINER SIZE u Draft Hood _ Regulator Filters Size Number Chimney Location n idy?,?/ //,,,?'OOutside Chimney Construction ??(Uf/ Smoke Bomb Wiring y Draft 64LX!:? Test Tog Door Pressure Lighting Inst. Date Tested !4-Z6_ GO 7 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetoonnkk?a, MIN 55343 Name of Tester Af ij"L/JNON / HEATING TEST RECORD ,-1 ADDRESS I5G 11D YTtor Id /sLAZ-Q AT, AP T.301 OOR ? CI SUB RB OCCUPANT OWNER 6trl??"` ?C J?"1 HEAT LOSS DA}? HTG. INST. - SOLD BY - Cllfaz 1-L U,_ INSTALLED BY yy? rf Electrical Work By V /' _ ADA ,C -• Cos Line By /C ?/f4rG.?C- Y TYPE OF HEAT GA -,,,fA Jtnf_-_HW -STEAM-SPACE HTR. -UNIT HTR. -OTHER AS DESIGN NVERSION MAKE - MAKE OF BURNER Model Model Serial Max. BTU Rating - INPUT MAKE OF FURNACE Model s V.I.. rX THERMOS& Vave Limit Limit Setting Fan Setting _ Pilot Type _ Pilot Make. Pilot Model Pilot Timing L.W. Cut Off JTROLS /, Heat Plug i Vent Size y fT KIND OF LI R 73- SIZE ? _ NONE "-- Draft Hood 0_' Regulator Filters Size Number Chimney Location s Ipsi l Outside z-?' s ` Chimney Construction fiWj t Pressure 7:? riJ Percent CO2 Input CFH '??? 5' ? Percent OZ Stack Temp. 1'1.Z3Lk Percent CO Smoke Bomb f Wiring f? Draft Y'! Test Toy Door Pressure / {? Lighting Inst. Date Tested -` - lQ / -° 7 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN.65343_ /I Name of Tester ,yI HEATING TEST RECORD ADDRESS I•?"/t••?yY1'iC4 -Lif/7Gt' ?I APT. FLOOR `CITtY SUB RB ?/ OCCUPANT ?? OWNER 01'hC[?i..? {*? HEAT LOSS AT HTG. INST. /^{ SOLD BY I mo( n INSTALLED BY A61444 ,or Electrical Work By Gas Line By N^Axrl cF C TYPE OF HEAT GA CFA-HW STEAM-SPACE HTR. UNIT HTR. OTHER , GAS DESIGN C • NVERSION MAKE MAKE OF BURNER Model K6/)/f-0-7&4-W_'_1 Model Serial CJ tJ `? - Max. BTU Rating _ INPUT -7 Sr O LAG' MAKE OF FURNACE Model Valve _fZC Limit Limit Settir Fan Setting Pilot Type Pilot Make Pilot Model NTROLS it _?' f Heat Plug Vent Size /- KIND OF LlKR _ -5 SIZE NONE Draft Hood y _ t_? @v R._gUlaror ?3 Filters Size !I0)Q0,y1 Number Chimney Location Irsiwde Outside Chimney Construction Pilot Timing Q ?-at? L.W. Cut Off Pressure ?'(?'^" Percent CO2 Input CFH 5•(70 Percent 02 Stack Temp. Percent CO Ia ?lGu F (ok 6 Smoke Bomb Wiring a. Draft ?'F1(7 Test Tag Door Pressure ?7 ?7 Lighting Inst. Do to Tested /u-I?-O-? Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka MN 5343 Name of Tester M_ 7;, f,&) ?V%/J /HEA•I G TEST RECORD ADDRESS-`ry?G_ / APTOOR CITY __tSUBURB OCCUPANT - ?' OWNER •t?t'JYY\Et--u-? fV?ij'?J,An.JrY.?izr, HEAT LOS ATE G. INST. - SOLD BY 17 % ATE INSTALLED BY Electrical Work By A _ - Gas Line By KUV _j `Pj2 TYPE OF HEAT GA FA t__`HW -STEAM -SPACE HTR. -UNIT HTR. OTHER n? )AS DESIGN CO VE SION MAKE Y MAKE OF BURNER Model Model Serial. !q I f Z - Max. BTU Rating INPUT MAKE OF FURNACE Model Valve Limit Limit Setting Fan Setting _ Pilot Type Pilot Make - Pilot Model _ LS Plug Vent Size KIND OF LIN SIZE NONE Draft Hood / Igip Regularor Filters Size ??nX 7-AM Number. Chimney Location side OLutside Chimney Construction Pilot Timing L.W. Cut Off r Pressure ?•? ( Percent CO, Input CFH Percent OZ tali, & Stock TemP• Percent CO E Smoke Bomb Wiring Draft Test Tag Door Pressure Lighting test. /D Date Tested Company Testing - Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, N 55343 Name of Tester ? c 4 H ATING TEST 2R,,/E/CORD 4 ADDRESS APT.7?FL00R2 OCCUPANT OWNER HEAT LOSS ?ATF G. INST. SOLD BY INSTALLED BY • P Eletirital Work By a- Gos Line By I on TYPE OF HEAT GA _1LFA JGHW STEAM SPACE HTR. -UNIT HTR. OTHER GAS DESIGN ONVERSION MAKE MAKE OF BURNER Model 'C Model Serial Max. BTU Rating INPUTS/??7 ?7 MAKE OF FURNACE Model ?-- ONTROLS THERMO T _ Heat Plug Vent Sire It _ ll Valve KIND OF LI R SIZ!2j<NONE Limit Draft Hood Regulator ?_ Limit Setting C:v Filters Si.J Number Fan Setting I Chimney Location ?In Ide - Ou side ?? Pilot Type -/ Chimney Construction ?/?• -? , Pilot Make Pilot Model L Smoke Bomb Wiring v Pilot Timing -?-? Draft 49?-7-7 Test Tag L.W. Cut Off ?- Door Pressure `lp Lighting Inst. Pressure Percent COZ Date Tested 16 /f `R Input CFH ??r0 ercent OZ ' Company Testing -Rouse Mechanical, Inc. Stack Temp - Percent CO 11348 KTel Dr. Minnetonka ) Name of Tester / 43 C? `?,y, 7 ADDRESS'`)lQ ' r?>'???? `? , HEATING TEST RECORD . r- -1 APT.- LOO r ,, \/ S U URB*L OCCUPANT .^ R OWNER - I n ,J - ? --?? - P HEAT LOSS ATE SITG. INST. ' A62 I e ett ? SOLD BY a INSTALLED BY L ms - - Electrical Work By Gos Line By .?+0 - TYPE OF HEAT GA _._j,,,FA N STEAM SPACE HTR. -UNIT HTR. - OTHER GAS DESIGN CO VE SION ? MAKE- MAKE OF.BURNER Model -" Model Serial - - 7 Maz. BTU Rating INPUT MAKE OF FURNACE Model Pilot Timing R??Dri L.W. Cut Off Stack Temp. Percent CO G_(C2 _AVO or-7 CONTROLS Pressure !C 4 Percent C02 ?S Input CFH .Oex) Percent 02 /` ?pp rU Vent Size KIND OF L ER_ SIZE sc? NONE Draft Hood Regularor 7S -:7- Filters Filters Size Number ,/ Chimney Location Insi a Ou?tt -dde of Chimney Construction ,? I Smoke Bomb Wiring L? Draft /Q - Test Tag Lighting Inst. Door Date Tested W-6- Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minneto_ nka, MN $5.34 ^? Name of Taster 1??Tyr-`Jyl u I/Xtq 7f7fOwi f?L1 Jl ?-1 HEATING TEST ? RECORD ADDRESS 1 ? rt J n-)'?1?i.^ ZD -+` / - APT'`J`?'(?' OORCI SUBU B ??--M?\/ OCCUPANT -? OWNER HEAT LOSS D TE ITG. INST. SOLDBY- 6111119-=; Y t00 - _ INSTALLED BY - n 44' Electrical Wert By M E! - Gas Line By TYPE OF HEAT GA _ I FA L_?'HW-STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN ON ERSION MAKE ? MAKE OF BURNER Model Q (A 'C -7, Model Serial _ - Z? Z 7f Max. BTU Rating INPUT c ii OF FURNACE Model Valve Limit Limit Setting Fan Setting _ Pilot Type - Pilot Make - Pilot Model _ CONTROLS - Heat Plug Vent Size l '- KIND OF LIN R ` Draft Hood Pilot Timing L.W. Cut Off Pressure I-PercentC02 Input CFH c 'Ip0 Percent OZ A Stock Temp. ??? Percent CO 0174 Filters Size-1 Chimney Location Chimney Construction SIZ Regulator _ -Number_ E Smoke Bomb /Wiring Draft [ N ?_ Test Tag - Door Pressure 6- Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka N 5$ 3 /? ; / J Name of Tester t O,IC G C t-}'-JL`-^,y?? HEATING TEST RECORD !g ADDRESS 1610 ' I LO rf V r' r-'?' `?-? ?,? • APT.' ?t i L00R2? CIJ???T OCCUPANT OWNER E)000 ltM (r HEAT LOSS 4- D? TE H/TG. INST. SOLD BY INSTALLED BY Electrical Work By Y?,f0 1 (tf to Gas Line By ? TYPE OF HEAT GA LFA ?HW STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CONMVE SION MAKE LJ MAKE OF BURNER Model -?' 2V - Model _ i Serial 3 Max. BTU Rating _ INPUT ?? MAKE OF FURNACE Model THERMOSTA Valve Limit Limit Setting Fan Setting _ e Pilot Type Pilot Make _ Pilot Model _ V I muLa rr S Heat Plug Vent Size KIND OF LI R Draft Hood Regularor _. fr CD-Is ar Filters Size Number r Chimney Location Inside Chimney Construction Pilot Timing ??-?-?-- L.W. Cut Off Pressure Percent CO 2 14 c it Input CFH rPercent 02 OZ Stock Temp. Percent CO -? Smoke Bomb Wiring Draft Test Tag d ? v Door Pressure ``,, Lighting Inst. Date Tested /y -tc? Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetgnka, NN 55343LXp. n? Name of Tester 7T??arr`1C/!/.(X1.(LA-r /?C} //LAL-(L! G??j HEATING TEST RECORD ?? ADDRESS 'y'vQQ//l??O?P/' APT. OOR'? CITY SUBUB OCCUPANT OWNER HEAT LOS?5? D'?TE HTG. INST. /? SOLD BY V?LL -C-1 fPCdif ' INSTALLED BY.SCO6 E? Electrical Work By 9 .Lt1LC Dlr' Gas Line By Z? TYPE OF HEAT GA _1L7 A -STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE ^ MAKE OF Model v, -,sz Model - Serial Max. BTU INPUT OC7 MAKE OF THERA?.jSjA Valve Koh Limit Limit Setting Fan Setting _ Pilot Type - Pilot Make CONTROLS Model Rating FURNACE 4 Vent Size KIND OF LINER Draft Hood Filters Size _l Chimney Location Chimney Construction Regulator Pilot Model 7« Smoke Bo Wiring /l Pilot Timing ?-SP?- ' Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure •t7 'r't'? Percent C02 nput CFH 45i'? Percent 02? G Date Tested /0 -Z 6 _1 Company Testing -Rouse Mechanical, Inc. Stack Temp. -Percent CO D 11348 KTel Dr. t onk MN Miin nee 343 Name of Testa, nn/ ? - FJ,C -d BURNER HEATING TEST RECORD ADDRESS 1121- APT. OOR ITY? SU RB OCCUPANT OWNER q 0 -71 0a - HEAT LOSSQ j DAT HTG. INST. SOLD BY _?Cl llRdl? gj INSTALLED BY .ESL (P(' l Electrical Work By %V_ // u i,w I ?((= Gas Line I D / t0 /1 TYPE OF HEAT GA _scFA 4:?HW - STEAM-SPACE HTR. UN IT HTR. OTHER GAS DESIGN CON E SION ?.1(,1:? MAKE ??-? MAKE OF BURNER Model 'J - Model Serial - ?? ?7'? Max. BTU Rating INPUT / MAKE OF FURNACE Model Va Iva __PClta Limit ? Limit Setting Fan Setting _ Pilot Type y Pilot Make _ Pilot Model _ Pilot Timing L.W. Cut Off CONTROLS Heat Plug Vent Size / I- KIND OF LIN S SIZE NONE` Draft Hood My /Regulator ? 1 T Filters Size -6/x/1 7t_ Number 7 Chimney Location I si 0-yu??-side Chimney Construction ,,T/?" r E; r. Pressure ?G Percent CO2 n Input . Percent OZ Stock Tememp Percent CO n Smoke Bomb ?r Wiring 1? Draft L ?-Test Tag Door Pressure L/ Lighting Inst. Data Tested j 0-f5-'a-2 Company Testin g -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka , MN,5?34 Name of Tester ??_Cf/ ' r d"""" ?!l HEATING TEST ?R/Ej?CORD ?r??,n+4 ADDRESS IS4y`I lzrm 06 >ol AP T.'94F-LOORS?CI TY SU URB (T OCCUPANT OWNER HEAT LOSS _N AT i DI f, HTG. INST. n SOLD BY ?(6i?GG1_2- '+ + - ?INSTALLED BY, /1"lAt3 0 1On Electrical Work By Gas Line By k444 4 ?42t 91 TYPE OF HEAT GA ___L?_FAc?HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER AS DESIGN CO VERSION MAKE MAKE OF BURNER _ Model Model Serial ?Z Max. BTU Rating INPUT 4 i?11 MAKE OF FURNACE Model ONTROLS _ THERMO 5 TA Heat Plug z7 Vent Sire ? J ( Valve t 1Ul ? I0,( aA /r- KIND OF LI R - J SIZE 51 BONE Limit .C/!,(w Draft Hood Br Regularor ? Limit Setting Filters Si,, .r I Number Fan Setting yy?? •w? Chimney Location ns de Out ide f Pilot Type /t'1-t -LM Chimney Construction ?4 1%_ Pilot Make k F0 ?1 L - Pilot Model U 'T Smoke Bomb Wiring Pilot Timing Draft Test Tog / L.W. Cut Off p7 Door Pressure /'1` c/ Lighting Inst. y Pressure ? Percent CO2 `v Date Tested w_/ p /- o Input CFHPercent OZ i!57).10 Company Testing -Rouse Mechanical, Inc. Staek Temp. ?(?j°? Percent CO 11348 K-Tel Dr. Minnetonka,MN 55343 /! Name of Tester TC •_ 'A(U4VA' 6LfUMM / HEATING TEST RECORD / ADDRESS ?•?? ? `?( 1T? -?? -APT :? _ 1 OR CITY SUBUR -? OCCUPANT ? -' OWNER n'?'1Gt'<^"' -E1Y!----?_[-L n t HEAT LOSS ? ? DATE TG. INST. - D SOLD BY INSTALLED BY ' !?, t?'I g= • - Electrical Work By ??'-- Gas Line By TYPE OF HEAT GA A _ HW -STEAM SPACE HTR. - UNIT HTR. -OTHER GAS DESIGN CO VERSION MAKE MAKE OF BURNER _ Model / Model Smial t - n?/ Max. BTU Rating INPUT MAKE OF FURNACE Model ?CUNTKOLS `_ 1r THERM T T ?- Heat Plug Vent Size ? Valve KIND OF LIIDn}ER SIZE NONE Limit Draft Hood IDU-_-_ (7-Y"N Regulator Limit Setting t?0? c Filters Size 1(jj/4 7?/C Number c Fan Setting _ Chimney Location nside Outside Pilot Type Chimney Construction S Pilot Make Pilot Model Smoke Bomb ?.,? Wiring I/ Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Ptbasure ? Percent C02 Date Tested [O -19 Input CFH - Percent 02 Company Testing -Rouse Mechanical, Inc. Stock Temp. Percent CO ?D 11348 K-Tel Dr. Minneton a4 Name of Tester -`-?Y-F`{i? (CC ^?-1 Y4""-"" /?JH??EATING TEST RECORD ADDRESS 66??o z? -1W, APT.OOR? CITY OCCUPANT OWNER YeJL112?/?.?+ HEAT LOSS, TDfTE JITG. INST. SOLD BY INSTALLED BY Electrical Work A 0 1.? Gas Line By TYPE OF HEAT GA __4fA ?W STEAM SPACE HTR. UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF BURNER_ Model - Model Serial ?`? - Z Max. BTU Rating _ INPUT MAKE OF FURNACE Model r- CONTROLS THERMO A 2 Heat Plug Valve Limit Limit Setting Fan Setting _ Pilot Type Pilot Moke Pilot Model Pilot Timing c9!S 2e - L.W. Cut Off Vent Size KIND OF LIN SIZE?Sc/ NONE Draft Hood Regulator 7 S-? Filters Si.. (/n719)'r ( Number Chimney Location ?azi e f ?0 Tsi a Chimney Construction i( Smoke Bomb- Wiring Draft ny9 _ Test Tag Pressure Percent COQ-,C Date Tested Input CFHy?rCtec?.!Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp.Q !- Percent CO 11348 K-Tel Dr. Minnetonk 5 343 Nome of Tester _/ 1 X.CtiOTIPd CON ATING TEST ?RECORD ADDRESS ? ?j? ? J3 _ APT., QOR _ CITYR SUBU OCCUPANT OWNER ?Z(-? HEAT LOSS p ? TE G. INST. 7 w) SOLD BY ? INSTALLED BY M / / D /-HO/=,!/1 . Electrical W.+rk By .( .t?-4- Gas Line By - ? T In 9 wn TYPE OF HEAT GA VV_A_HW - STEAM SPACE HTR. -UNIT HTR. OTHER AS DESIGN CONY RSI N MAKE MAKE OF BURNER _ _ Model ? Model Serial a Max. BTU Rating _ INPUT MAKE OF FURNACE Model Valve 4KJyj Limit Limit Setting Fan Setting _ Pilot Type Pilot Make - Pilot Model _ Pilot Timing L.W. Cut Off V IKULJ tI^ ?/? Heat Plug Vent Size KIND OF LI R Q-ZATSIZE NONE Draft Hood Regulator Filters Size Number Chimney Location I sid 7'_Ouwtside Chimney Construction Pressure Percent CO2 ?f Input Temp. Percent OZ Stack Temp. Percent CO ? . Smoke Bombl! -Wiring f ?? Draft CSI Test Tag Door Pressure Lighting Inst. Date Tested 1(2-z,6-w-7 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. 'n looks, MN 534 ? Name of Tester C HEATING TEST RECORD 1?9c?oYrrfo K. ADDRESS APT. OOR CIT SUB B OCCUPANT OWNER ?nn relivn p1Y15 HEAT LOSS AT TG. INST. SOLD BY INSTALLED BA O['- Electrical Work By Gas Line By $:fm4 w(` - TYPE OF HEAT GA. l??FA HW-STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF BURNER _ Model Model Serial - - ?z Moz. BTU Rating INPUT MAKE OF FURNACE THER Valve L Limit Setting Fan Setting _ Pilot Type ...? Pilot Make 5 Pilot Model _ ERSION Model JTROLS Heat Plug Vent Size r. ~ KIND OF LI R SIZES NONE ?r^ Draft Hood I&AjtCEYN Regularor 3Z5_ r Filters Size ?7X f Number - side T Chimney Location n ide 4 0 Chimney Construction a'1n5 Pilot Timing L.W. Cut Off !1 Pressure Percent COZ 5 d9? Input CFH ?p°, c1C7 Percent OZ. Stack Temp. -iL?J?? Percent CO ?? Smoke Bomb Wiring t? Draft ? Test Tag Door Pressure Lighting Inst. t/ Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN/lSQ?/(-43 Name of Taster / `? ttz; O.rC_J 15112 ?? (?Q t +'? E ATING TEST RECORD ? K ?' ^ ' \1 , ( ADDRESS L -i -/ APT.` ?',?`'??'OR `° Cl SU URB LdXY? OCCUPANT OWNER d/37Y u I?dF 1) - I HEAT LOSS TE H G. INST. - SOLD BY INSTALLED BY L {? 0 ?r Electrical Work By A - Gas Line By h?_?Q )/ScQx Ms&(', TYPE OF HEAT GA -HW - yT STEAM SPACE HTR. -UNIT HTR. -OTHER S DESIGN O NVERSION MAKE MAKE OF BURNER Model _e Model Serial 7-fiZ Max. BTU Rating INPUT ' d6 MAKE OF FURNACE Model Limit V Volvo Limit ??LIL.?. Limit Setting Fan Setting _ Pilot Type Pilot Make . Pilot Model 1 ? CONTROLS ?H at Plug Vent Sixe KIND OF LI R _ SIZE LNONE -- 1 Draft Hood Regulatorz S 3 Y-'Cl Filters Size Number - Chimney Location :ate Chimney Construction 1?/Y'( !??-?x"?S Pilot Timing L.W. Cut Off Pressure R Jr Percent C02 00 Input CFH D Percent OZ Stack Temp. Percent CO Smoke Bomb Wiring // Draft C7UV rZ Test Tag Door Pressure Lighting Inst. Date Tested k)-2,6-5N Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka ?553J43 Name of Tester l..t / //n EATING TEST- I RECORD ADDRESS 'v rTJ./' APT LOOR T?-SUBUR OCCUPANT OWNER J HEAT LOSS TE TG. INST. SOLD BY INSTALLED BY Qln,,ate- Electrical Work By Gas Line By [<M?kA `? - TYPE OF HEAT GA FA HW -STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE _ MAKE OF BURNER_ Model Model Seri ol Max. BTU Rating INPUT C?'O/C?C7 MAKE OF FURNACE Valve _?! Limit -f1-JKnl?l Limit Setting Fan Setting _ Pilot Type s Pilot Make Pilot Model _ CONTROLS - Heat Plug Pilot Timing L.W. Cut Off Pressure 3 ' ? Percent C02Q C?b Input CFH p Percent 02 Stack Temp. 0 Percent CO Model e C t T t 'S?t Vsnt Size KIND OF LI R SIZE NONE Draft Hood c`1 Regularor . Z Filters Size ( Number Chimney Location I side Out ide C-___? Chimney Construction Smoke Bomb Wiring ^ Draft Test Tag v Door Pressure Lighting Inst. Dote Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. innetonk M? N 55343 Name of Tester ??/?, ?,/ HEATING TEST RECORD 2 ADDRESS's?L f'I (j]71f9521,. APT. OOR?L CIT SUBU B? OCCUPANT OWNER ;Z - Ar-k)(' HEAT LOSi--?yDATj€HTG. INST. - SOLD BY IX -? ? INSTALLED BYoC f Electrical Work By luax lA:i A Flj Gos Line By IAa e r17 C' TYPE OF HEAT GA,r2GFA ??HW-STEAM SPACE HTR. UNIT HTR. -OTHER MAKE. Model Serial J INPUT GAS DESIGN MAKE OF BURNER Model Max. BTU Rating MAKE OF FURNACE Model tt_ -v Vent Size KIND OF LI R SIZE rt NONE Draft Hood 'CZ ?on Regularor Z - Filters Size Number Chimney Location I?s/i de ; O tside?J Chimney Construction -' S Valve Limit 14 Limit Setting Fan SettingG Pilot Type Pilot Make Pilot Model _ CONTROLS - Heat Plug Pilot Timing -, L.W. Cut Off -? Pressure 3• S'l file- Percent CO2_j^5,n Input CFH 4 ?i? Percent OZ Stock Temp. Percent CO Dc7d Smoke Bomb_ r Wiring Draft ?-.?' / Test Tag I? Door Pressure ? i Lighting Ins+Date Tested ?? - d 7 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. MMiinneto ka, MI 5343 Name of Tester 7l I JcMrr?. D? HE TING TEST RECORD ADDRESS 6 6 ttAdlll APT FIR: ITY OCCUPANT OWNERa TYYYIim HEAT LOS A E H . INST. SOLD BY INSTALLED BY Electrical Work By - Gas Line By LP TYPE OF HEAT GA 1GFA Z W -STEAM SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN C NV RSION MAKE MAKE OF BURNER Model _ Model Serial ~ _ Max. BTU Raring INPUT ?75+ Cock MAKE OF FURNACE Model lUNIKVLJ ?r el THERM T T Heat Plug Vent Size 41 Valve Alf= KIND OF LI ER SIZE NONE Limit Draft Hood Regularor Limit Setting Filters Size 49xzoX I Number Fan Setting Chimney Location I i e side ? Pilot Type Chimney Construction Pilot Make 6 Pilot Model Smoke Bom Wiring Pilot Timing -?? - Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. it ?? J? Pressure Percent C02 Dote Tested 'N c.y9 V Input CFHPertent 0? Company Testing -Rouse Mechanical. Inc. _yy Stack Temp. !!fl OCTE Percent CO 11348 K-Tel Dr. mneto 55343 Name of Teste?? ATING TEST RECORD ADDRESS (R'n12 APT. OORO Y SU RB OCCUPANT OWNER ih'i\-f9nin HEAT LOSS TE G. INST. _ SOLD BY INSTALLED BY Electrical Work By Gas Line ey 'e TYPE OF HEAT GA ? W STEAM SPACE HTR. -UNIT HTR. OTHER GAS DESIGN C VERSION MAKE MAKE OF-BURNER Model - Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model f CONTROLS THERM A / Heat Plug Valve Limit Limit Setting Fan Setting Pilot Type Pilot Make BDba? Pilot Model _ Pilot Timing L.W. Cut Off l,?q Pressure Percent CO2 Input CFH y Percent OZ az Stock Temp. Percent CO 0 /p ef , Vent Size ti KIND OF LINER SIZE Draft Hood -7 Regularor Filters Size X Number Chimney Location Os de utside Chimney Construction C Smoke Bom ? 41_?T Wiring Draft Test Tag Door Pressure Lighting Inst. Date Tested 16 -2?7 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Or Minnetonka, MN 55343 Name of Tester A / /? ATING TEST RECORD ADDRESS (1yy{?/n [/ APT. OOR CPY SU URB? OCCUPANT OWNER ,tOOR ?(iv1 °,/M? 1?C' I? HEAT LOS AT HTG. INST. SOLD BY 10(' INSTALLED BY rTl-LO CPO Electrical Work BY Gas Line By j'74Q Q e TYPE OF HEAT GA _?W -STEAM SPACE HTR. -UNIT HTR. -OTHER P1 GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model - 7 - Model Serial (2541 3ZYC2 2-- - E339-7 Max. BTU Rating INPUT MAKE OF FURNACE 14 Model CONTROLS tt? tl THERM A Heat Plug Vent Size Valve KIND OF LI R ?? SIZE ?_ NONE Limit Draft Hood ?' Regularor c Limit Setting Filters Size ?XL4 'Number f Fan Setting _ Chimney Location //I??sdff utside Pilot Type Chimney Construction ?? .? .? Pilot Make I-T e Pilot Model -' W - Smoke Bomb Wiring Pilot Timing Draft s Test Tag L.W. Cut Off ! Door Pressure ''-7 Lighting Inst. Pressure ?Percent CO 0 Date Tested 4??/ Input CFH Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Tamp. Percent CO --F+ ??XXf6??? 11348 Kdel Dr. Minnetonka, MN 5343 Name of Tester ,,?? nH/EATING TEST 0 D 1 0 ADDRESS' (dke -'• APT. FL ORa CITY SUBURB( OCCUPANT ~^ OWNER Mn (_,?1'1Trg HEAT LOS D TE HTG. INST. _7 ,?///?? SOLD BY INSTALLED BY V?[J]A4=P tD/f Electrical Work By ? Gas Line By CM D 7 TYPE OF HEAT GA J1'rA ?HW -STEAM -SPACE HTR. UNIT HTR. -OTHER GAS DESIGN CONJ ER ION MAKE -- MAKE OF BURNER Model - Model Serial 3J Mox. BTU Rating INPUT /0Orcop MAKE OF FURNACE Model CONTROLS THER T T ?F He t Plug 11 Valre Limit Limit Setting Fan Setting Pilot T pe y Pilot Make Pilot Model A Pilot Timing - L.W. Cut Off ?0 Percent COQ Pressure 3 -C:;' Percent OZ Input CFH CD1 v( - ? `x'0)0 J L- y, Stack Temp. Percent CO r/ / rr Vent Size 'f0 KIND OF LI?NNER?? SIZE J&// NONE Draft Hood ?Zr-± vRegularor r-? Filters Six Number / Chimney Location I side ---Out de Chimney Construction _L( Smoke Bomb Wiring Draft ?•??r Test Tag-- Door Pressure Lighting Ins Date Tested 7-2 -R2 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka..MN 55343 Name of Tester A44"- I VV(S _m j D / HE T NG TEST RECORD %?`?y/,1 /]=\J1 -FL - ADDRESS APT. OORe( 7Y ?SU?URB- I OCCUPANT OWNE?Lm77tL3YJll HEAT LOSS D TE TG. INST. SOLD BY ?PZ INSTALLED BY Electrical Work By Gas Line By TYPE OF HEAT GA _.FA _HW STEAM SPACE HTR. UNIT HT-R. OTHER GAS DESIGN CONVERSION QA r MAKE MAKE OF BURNER Model UFA Model 11 / a Serial Max. BTU Rating INPUT MAKE OF FURNACE Model _ CONTROLS ell THERM TAT F Heat Plug Vent Size Valve 10 Vv KIND OF LINER• SIZE_NQNE Limit Dra Ft Hood Regulawr ?Z 5 ?? Limit Setting Filters Size Number Fan Setting Chimney Location In i 0utside Pilot Type Chimney Construction w Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing - Draft 6znd Test Tag L.W. Cut Off t?G-?'?^ vv77 Door Pressure r? Lighting Inst. Pressure 36r to Percent C02 ?? Date Tested 4 Input CFH iym nt OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. ?0 °F Perce Percent CO 11348 K-Tel Dr. Mtnpetonka, MN55343 ' Name of Tester A Ly't. -L r-'?fJc?)'1J-?`? ® HjrtJp?ATING TEST RECORD ADDRESS 64 '?LLp11 EGL`[? k 1 . APT. OOR C_/5_U?B?URB _* OCCUPANT OWNERR,(LA-?LIt 11 DVS HEAT LOSS AT' H G. INST. SOLD BY Q,00 - n INSTALLED BY Electrical Work By - Gas Line By TYPE OF HEAT GA _ FA HW -STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE QA t/hC MAKE OF BURNER _ Model - l Model Serial Max. BTU Rating INPUT Jdr 000 MAKE OF FURNACE Model CONTROLS THERM T-r Hear Plug Va lre Limit ^ Limit Setting 1 ' d Fan Setting Pi I of Ty pe r?T Pilot Make ERSION Ir_ y Vent Size KIND OF LINER SIZE NDN E_ Draft Hood Regulator JZ? Filters Size Num er Chimney Location I si a de Outside Chimney Construction MIP Q Pilot Model Smoke Bomb ng Pilot Timing Draft Test Tog L.W. Cut Off Door Pressure Lighting Inst. c rr ?7G Pressure S l Percent CO2 Dote Tested -Jo 'G O ' 97 Input CFH ?O Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 KTel Dr. mn ionk N 5 343 Name of Tester __15C M TING TEST RECORD ???,/ ADDRESS r ru[ o APT. ?LLO,.O„R?K UBURB OCCUPANT ? OWNER oYl I r C.t-t^'t L%[1145 C rS HEAT LOSS f ?DAT ?JG. INST. X-U SOLD BY Ti 6?1?5 / - n INSTALLED BY Electrical Work By 0 I.IOA lr? - Gas Line By TYPE OF HEAT GA _ FA HW STEAM -SPACE HTR. UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF BURNER - Model Model Serial Max. BTU Rating INPUT ??[ MAKE OF FURNACE Model % CONTROLS i J THERM AT Heat Plug Vent Size Valve KIND OF LINER _ SIZE NONE Limit Draft Hood Regulator 3 Z Limit Setting Filters Size Number Fan Setting Chimney Location ?n ide utside -? Pilot Typed Chimney Construction /`r S Pilot Make Pilot Model Smoke Bom6 Wiring Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure ~r Lighting Inst. ''3'? 555? h/. C Pressure Parcent COZ Date Tested /O -7a _ a x Input CFH ipC- /? " Percent OZ Company Testing -Rouse Mechan ical, Inc. Stack Temp. AIR ?lvLddC FF Percent CO 11348 K-Tel Dr. net nka, d 'Y43 Name of Tester U EATING TEST RECORD ADDRESS 7l/ Iy? `?' APT. LOOR OCCUPANT OWNE?' HEAT LOSS D MG) INST. _ SOLD BY m.?y"q?]?CA INSTALLED BY Electrical W k By /J IZ4 Gas Line By TYPE OF HEAT GA _ FA _HW STEAM SPACE HTR. -UNIT HTR. ' GAS DESIGN MAKE - MAKE OF BURNER_ Model Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model TAT Valve Valve Limit Limit Setting Fan Setting ? Pilot Type _: Pilot Make SUBURB OTHER CONTROLS -Ile I 1/ `- - Heat Plug Vent Size KIND OF LINER SIZE NONE -- f Draft Hood Regulator 7iJ ?3 Filters Sim Number `? Chimney Location (`ten id Outside Chimney Construction r,?Y/t Ll? Pilot Model Smoke Bomb Wiring Pilot Timing O Draft 1&0 Test Tag L.W. Cut Off Door Pressure Lighting last -o Pressure Percent COZ Date Tested 7 It - ?{. Input CFH Percent OZ Company Stack Temp. :Fj. <)C _-Percent CO Testing -Rouse Mechanical, Inc. 11348 KTel Dr. M_ ipnetpnka„SIN 55343 Name of Tester X0 4N-? 2004 COMMERCIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 f Foundation Only New Building Interior Improvement • Structural Plans (2) sets • Architectural Plans (2) sets • Architectural Plans (2) sets • Civil Plans (2) • Structural Plans (2) • Code Analysis (1) • Certificate of Survey (1) • Civil Plans (2) • Project Specs (1) • Code Analysis (1) • Landscaping Plans (2) • Key Plan (1) • Project Specs (1) • Code Analysis (1) " • Master Exit Plan (1) • Spec. Insp. & Testing Schedule " • Certificate of Survey (1) • Energy Calculations (1) not always" • Soils Report (1) • Spec. Insp. & Testing Schedule (1) " • Elec. Power & Lighting Form (1) not always- • Meter size must be established • Meter size must be established • Meter size must be established-if applicable 1 • Project Specs (1) 1 • Energy Calculations (1) 1 • Electric Power & Lighting Form (1) " l L • Master Exit Plan (1) 1 1 • Emergency Response Site Plan (1) 1 • Soils Report (1) l • SAC determination - call 651-602-1 000 • SAC determination - call 651-602-1000 SAC determination -call 651-602-1000 Call MN Dept of Health at 651-215-0700 for details regarding food & beverage or lodging facilities. ** Contact Building Inspections fo r sample and if required when it states "not always". ** * Permit for new building or addition will not be processed without Emergency Response Site Plan. / C) 3 / ) l r-? 5 Date , / Constru ction Cost 0 1 0 0 0 Site Address l S q0 T/?a s G r/GG /] r- * Unit/S te # Tenant Name I L_ < 777- 14 7rFormer Tenant Name Description of Work ?+ 1 C.. - O !.• 5 r ?^-f? / Property Owner 17 o , • n 11 La Telephone # ( ) A ? l? Contractor , G e C e rr 5 y C Address 80 t-?. -fa .-4e- ea,7 City L-t f le. State " tJ Zip SS/i 7 Telephone # (loS? qif .?> - Oa 7C? r-+ 1 J L ;" C l? v 2 v Arch/Engr Registration # Address City State < ?\ Zip Telephone # ( ) Licensed plumber instal ling new sewerlwater service: Phone #: ( ) I hereby apply for a Commercial Building Permit and acknowledge that the information is complete and accurate that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of W Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without I permit; that the work will be in acco ance with the approved plan in the case of work which requires a review ant ap vat of plans. Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 26 Public Facility ? 30 Accessory Building ? 14 Apartments C 27 Commercial/Industrial ? 32 Ext Alt-Apartments ? 15 Lodging C 28 Greenhouse J 34 Ext Alt-Commercial ? 25 Miscellaneous C 29 Antennae C 35 Ext Alt-Public Facility ? 37 Nail Salon Work Types ? 31 New ? 35 lint Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' 643 Reroof ? 46 Windows/Doors ? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation ?? 000 Occupancy AD /7- MCES System - Census Code Zoning R City Water ` SAC Units - Stories - Booster Pump Nbr. of Units - Sq. Ft. - PRV Nbr. of Bldgs '--- Length -' Fire Sprinklered Type of Const Width Required Inspections Footings (new bldg) Footings (deck) Footings (addition) _ Foundation Drain Tile ?Roof Ice Pr _ Decking _ Insul _ Final - Framing - Fireplace - R.I. -Air Test -Final _ Insulation _ Final/C.O. i?Final/No C.O. Other Pool _ Figs _ Air/Gas Tests - Final Siding _ Stucco - Stone Windows Approved By: Planning I*R Building Inspector Base Fee Surcharge Plan Review MCES SAC City SAC Water Supply & Storage S/W Permit SAN Surcharge Treatment Plant Park Dedication Trails Dedication Water Quality Copies Other Total GV- q,a5- ,qS 4) 0 J(* b to 91 62S? IC5? 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS -' FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For: Fw(DD -1. Valuation: Site Address 540 TN01-1.1_K.FbIWTE Lot L Block Parcel/Sub ?/?M. FOl wre Owner-WA l.aLCo lfLk?l?t??? {?. Address 3}C?n l)?g,?y ?(y e City/Zip Code Pl?,v yVlrv• ?/?F/ Phone (oI?? - SSS?n+ 1 Contractor ?J6MAIn l).JY(rTU2S, ?/+c Address _ l ?(> 14ftyt o City/Zip Code Phone (1- $-51L / 7 Arch. /Engr.'??-)hcIdv", -')UyCr&rn Address 4 74 7TI/I,,' Lev ev IY (D/ , City/Zip Code Phone # ??? - Co33? Erect ,/ Remodel Repair _ Addition Move Demolish Int.Impr. Install APPROVALS Date: Occupancy Zoning Type of Const # of Stories Length Depth Sq Ft FEES Assessments Permit Water/Sewer Surcharge Police Plan Review Fire SAC Engr Water Conn Planner Water Meter Council Road Unit Bldg Off Treatment P1 APC Parks Variance Copies TOTAL NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. /3U70 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS 60 FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS CtlMMF.R(TAT. INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For: hp-r, P?LD(). Valuation: $ 1,725,000 Date: 11/18/86 Site Address 1540 Thomas Lake Pointe Lot 4 Block 1 Parcel/Sub T40t'1 A5 LRKe ?pl f l t1: Owner Address 3140 Harbor Lane City/Zip Code Minneapolis, MN 55441 Phone (612) 559-1711 Contractor Domain Constructors Inc. Address 3140 Harbor Lane City/Zip Code Minneapolis. MN 55441 Phone (612) 559-1711 Arch./Engr. Johnson. Sheldon & Sorensen Address 10249 Yellow Circle Drive City/Zip Code Minnetonka, MN 55343 Phone # (612) 935-6337 OFFICE USE ONLY Erect ? Occupancy Z•1 8.? Remodel Zoning Pp Repair Type of Cons t5 i H?. 1L N Addition # of Stories 3 Move _ Length 3-1-) Demolish _ Depth 67 Int.Impr. Sq Ft Ol,OOo Install APPROVALS FEES Assessments Permit 495. T Water/Sewer Surcharge 190. Police Plan Review ZZ4.1.?s Fire SAC Z ,0?00. Engr Water Conn -Z4,QC0 Planner Water Meter N/A Council Road Unit I 97.o Bldg Off12.88 Treatment P1 -),(oz5. APC Parks N//t Variance Copies TOTAL 81 13a Z D K. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. * * CITY OF EAGAIV ?? EFL AT TDE OF * APPROVAL OF PERMIT, w APPLICATION FOR PERMIT * INSPECTION OF SEWER AND/OR WATER + * INSTALLATIONS WILL NOT BE SCHEO- w SEWER AND/OR WATER CONNECTION 1), UNTIL PERMIT HAS BEEN w * APPROVED. w * * w w w (Please Print) 1) PROPERTY ADDRESS: ??ffCJ n.it?, e Z7L ?T^ LEGAL DESCRIPTION: (Lot/Block/Subdivision or Tax Parcel ID ) IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: PRESENT ZONING/PROPOSED USE: ftn Year) ? COMERCIAL/REPAIL/OFFICE R-1 SINGLE FAMILY F7 INDUSTRIAL ? R-2 DUPLEX (Two Units) ? INSTITUTIONAL/GOVERNMENT ? R-3 TOWNHOUSE (Three + Units) ( Units) 4 APARTMENT/CONDOMINIUM ( <5<D Units) 2) TTY NAME: ADDRESS: CITY, STATE, ZIP: PHONE: 3) u ::• NAME• Cys ?j , For City Use Plumbers License: ADDRESS: // O r P Active Expired CITY, STATE, ZIP: No t recorded ' PHONE: S?Iy ?3 oG' MASTER LICENSE# 2 StaTf nitial 4) 1 NAME:o ADDRESS: CITY, STATE, ZIP: PHONE: E5-C'(NNECTION TO CITY SEWER CONNECTION TU CITY WATER C] OTHER 6) • r ? PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE ?? (Circle one) FOR CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit $ S FEES: $ /n 5z) SEWER PERMIT (INCLUDE SURCHARGE) $ WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER $ $ ACCOUNT DEPOSIT - WATER WAC ?U?? S Z J C) D U Z) $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $' LATERAL BENEFIT/TRUNK WATER $D 7? z S ?? $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ n ?: ?7 S d $ TOTAL ( J St??5"L)o -73?2? RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES IF YES, THEN A " PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY:r TITLE: DATE : / p 7 i ttt CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION NOTE: PAYMRNr' OF FEE AT TIME OF APPLICATION DOES NUT CONSTIT= APPROVAL OF PERMIT. INSPECTION OF SEWER AND/OR WMER INSPALT,ATIONS WILL NOT BE SCHED- ULED UNTIL PERMIT HAS BEEN APPROVED. Tzxxxxxrxxxxzxxzxrzrrzsxsxzxszrzrxzro (Please Print) 1) PROPERTY ADDRESS:. 15-40 iW2&d? A LEGAL DESCRIPTION: IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: PRESENT ZONING/PROPOSED USE: (bion Year ? COMMERCIAL/RETAIL/OFFICE 0 R-1 SINGLE FAMILY INDUSTPLaZ 1-1 R-2 DUPLEX (Two Units) INSTITUTIONAL/GOVERNMENT R-3 TOWNHOUSE (Three + Units) ( Units) yl R-4 APARTMENT/CONDOMINIUM ( r? ?) Units) 2) ADDRESS: CITY, STATE, ZIP: PHONE: 3) c NAME: ADDRESS: (ShL> is ('I-r- CITY, STATE, ZIP: 1g1A 1S' Z11a " W AI PHONE: MASTER LICENSE# -'r I,/ Active Expired Not recorded St Initial 4) •• • is NAME: ') v ADDRESS: CITY, STATE, ZIP: j& 5 W v ' ' e PHONE: 5) r •a• :o a• as - CONNECTION TO CITY SEWER CONNECTION TO CITY WATER rl OTHER 6) • Q PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE [3 PLEASE APPROVED PERMIT TO 1, 2, 3, 4, ABOVE r. n u (Circle 'e) 7) n JA/ • . /'/ FOR CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit S $ S $ `?I1I ` / ? L , J C? S $ ? (y J ??d ? ?o , ?o?°SUL ` RECEIPT RECEIPT WATER TAP (INCLUDE CORPORATION STOP) SEWER TAP ACCOUNT DEPOSIT - SEWER ACCOUNT DEPOSIT - WATER WAC SAC TRUNK WATER ASSESSMENT TRUNK SEWER ASSESSMENT LATERAL BENEFIT/TRUNK SEWER LATERAL BENEFIT/TRUNK WATER WATER TREATMENT PLANT SURCHARGE OTHER: TOTAL DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? Q YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: FEES: $ SEWER PERMIT (INCLUDE SURCHARGE) $ ?/ - WATER PERMIT (INCLUDE SURCHARGE) $ WATER METER/COPPERHORN/OUTSIDE READER $ S $ d_ S S s Z /- c-y --2.;? 3 cl-7 TITLE: DATE: i ITY USE ONLY .BL ""PATE: 1993 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN SS122 (612) 681-467S PLEASE COMPLETE FOR ALL COMMERCIAUINDUSTRIAL BUILDINGS. ALSO FOR MULTI- FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING U::.T. CONSTRUCTION _ ADD ON REPAIR WORK DESCRIPTION: wwu Ne c(° L 6kE PRe bC? CONTRACT PRICE: $ Soo FEE: 1% OF CONTRACT FEE. STATE SURCHARGE: $.50 FOR EACH $1,000 OF PERMIT FEE. MINIMUM FEE: $ 25.00 CONTRACT PRICE X 1% $ STATE SURCHARGE $ TOTAL $ SITE ADDRESS: Tl/omd:S 1_m:L TENANT NAME: 2&-m& /Akc ?'TIU(?IYTf STE. # OWNER NAME: .,K INSTALLER: S? /7 &_()S ADDRESS: ?- CITY: /116 (F ? C2y?C)//U? nn STATE: -/a/4) /) ZIP CODE: PHONE #: 3 ) ) "-. (r ?? 3t? FOR: CITY OF EAGAN IL: PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. NO. FIXTURES SHOWER WATER CLOSET BATH TUB LAVATORY KITCHEN SINK LAUNDRY TRAY HOT TUB/SPA WATER HEATER FLOOR DRAIN GAS PIPING OUTLET • minimum ROUGH OPENINGS WATER SOFTENER PRIVATE DISP. • Dag Cty. lic. U.G. SPRINKLER • home under cont. ALTERATIONS • to costing WATER TURN AR UN Res S u RE Ke- CXkQLZ:71? STATE SURCHARGE TOTAL: EACH TOTAL 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 1.50 5.00 15.00 3.00 15.00 15.00 .50 SITE ADDRESS: W) 117-OIM S /-A !y/14V Ulb-UI J 1 fi?%aUI(aJ1 OWNER NAME: ??r -?_ %h/Ul?/tS LK INSTALLER: l %?(?S CITY: 6-400 STATE: ZIP CODE: SS. n PHONE #: ( ) 7 3- ???0 1993 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PII.OT KNOB RD EAGAN MN 55122 (612) 6814675 %Hom„S LAKE POWr CONTRACTOR'S MATERIAL k TEST PART "A" GENERAL iss PROCEDURE UPON COMPLETION OF WORK. INSPECTION AND TESTS SHALL BE MADE BY THE CONTRACTOR'S REPRESENTATIVE AND WITNESSED BY AN OWNER'S REPRESENTATIVE. ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S MEN FINALLY LEAVE THE JOB. A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH REPRESENTATIVES COPIES SHALL BE PREPARED FUR APPROVING AUTHORITIES. OWNERS AND CONTRAC. TOR. IT IS UNDERSTOOD THE OWNER "S REPRESENTATIVE'S SIGNATURE IN NO WAY PREJUDICES ANY CLAIM AGAINST 'CONTRACTOR FOR PAUL" MATERIAL POOR . WORKMANSHIP. OR FAILURE TO COMPLY WITH APPROVING AUTHORITY'S REQUIREMENTS OR LOCAL ORDINANCES. PROPERTY NAME DATE - / (I -z of -97 PROPERTYADDAE55 -- J n - 'P') ivJ G ACCEPTED BY APPROVING AUTHITY('S)NAMES OR OR ITk(C - L-1?,eitkt-tj r I?If'K S(3ieU cL? O COµ1ati J'KC 1 It S • . t • ADDRESS p ?, nor ?? Nn ? sro ?OaR tC L? e SO PLANS ?cc? R-P_t MIN 0.% } w O ti S I H.• 1.? 5? 3 J ' INSTALLATION CONFORMS T ACCEPTED PLANS. yU [j.- NO ? EQUIPMENT USED IS APPROVED Yin Q? RO IF NO. STATE DEVIATIONS HAS PERSON IN CHARGE OF FIR' EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND CARE OF "rHis New EQUIPMENT' Yu m? NO IF NO. EXPLAIN INSTRUC- TIONS HAS A COPY OF INSTPURION AND MAINTENANCE CHART BEEN LEFT AT PLANT' Y[f [],1 NO IF NO. EXPLAIN PI.I:?HISU Plow the Ieuulrod rutr avid water Is clear ,a Indicated by no collection of foreign material In burlap mate at mauets such u e weals an blow-ofb. Flush it Ilnws nm lean than ;an :I'll fur 0-holh plpa and snwlleq 1000 GPM for 1-Inch pipe. 1000 GPM for 10-Inch Pipe, utd 2000 GPM for IL- Ih.h yna. When luppH cnuop.t muduce allpnlaled flow rates, obtain maxiinum available. TEST HYDROSTATIC Hydrosbttle tests shall be nmde .tl net less than M PSI for two hours or 50POI above ststle pressure In nexss of In PSI. Differ,mlal di).pipe Yah'e dripper. shall he left open during lest to prevent damage. All abovsgrsund piping leakage .Nall ma Hopped. DESCRIP- LF.ANAIIIC. Sew pipe bid with nAher gakel.dluint. eha1J, If the wneknmoshlp Is ao U.(. Hny. have little or no leakage of the Joints. The ' moon of leo Aage x1 the Joint. shall nut exceed 2 quarts lee' hour Per 100 Joint. Irreepeclively of Pipe diameter. The leakage elicit be dl.- uibuted -1c, all ].lots. If lurk leakage occurs at a few Joint. the Installation shall be considered unsatisfactory and necessary repairs TION nmde. Sew viler' laid With caulked lead it lead.eubetltme J,dnte shall. If the workmanship I. sell.factorn have little or no I.nknge al the Amua An) Aomt ha,le, leakage or same trim n 'slight dllli' eeplnf' shall he reWtbed. Leakage shall not exceed 1 oz. Ohpnd toeux. per haw 11c, inch of lip. diameter Per Wial. 'Th, leakage shall lue distributed mar all Joints. If such leakage ui,mr. Wuluston- tirely ut n few Joint., the Installation .hall be eoruldered tio-tafnrlon and nereaxara, repair, made. I-N-RUHATIC: Establish e0 PSI sir prsssurs and measure drop which shall not exceed 1% PSI In 21 hours. Test pressure tanks at borcheal water level and air pressure and msseur0 air w...Ire drop which shall not exceed 1A PSI In 21 hour.. PART "B" - UNDERGROUND PIPING O /Jp,?scS Fee1u BLOCS. LOCATION PIPE TYPES AND CLASS TYPE JOINT UNDER- GROUND CONFORMS TO STANDARD Yu O NO ? IF NO. EXPLAIN PIPES AND JOINTS NEEDING ANCHORAGE CLAMPED. STRAPPED. OR BACKED IN Yu No O (] 71000RDANCB WITH STANDARD JOINTS IF NO. EXPLAIN TESTS REQUIRED FLUSHING HYDROSTATIC LEAFAGE NEW UNDERGROUND PIPING FLUSHED AGCO NO TO STANDARD VAR, BY (COMPANY) HOW FLUSHING PLOW WAS OBTAINED, PUBLIC WA3glk ? TANK w 29MVGIM O Ian PUMP ? THROUGH WHAT TYPE O FLUSHING xys, gun. ? BPtN nn ? LEAD-INS PLUS ACCApDING TO ANDARD of 13 ' TESTS OMPA BY (L HO LUSHING PLOW WAS OBTAINBD? PUBLIC WAM p TANK M p voin ? nR PUMP p THROUGH WHAT TYPE OPENING: Y CONN. To rLANC[ a YIOOT D OP[N ram ? lira Ne. u Pew.f V U.B.A. HYDRO CTa TIt• ALL NEW IINDEPGPOUND PIPING HYDROSTATICALLY 'TESTED AT TEST PSI FOR HOURS TOTAL AMOUNT OP LEAKAGE MEASURED LEAKAGE GALS. HOURS TEST ALLOWABLE LEAKAGE GALS . HOURS NUMBER INSTALLED TYPE AND MAKE HYDRANTS ALL OPERATE SATISFACTORILY In ? NO ? WATER CONTROL VALVES LEFT WIDE OPEN: Yu ? No CONTROL IF NO. STATE REASON VALVES HOSE THREADS OF FIRE DEPARTMENT CONNECTIONS AND HYDRANTS INTERCHANGEABLE WITH THOSE OF FIRE DEPARTMENT ANSWERING ALARM? Tu ? No DATE LEFT IN SERVICE REMARKS PARTS A & R NAME OF SPRINKLER CONTRACTOR MR PROPERTY OWNER (SIGNED) TITLE T FOP SPRINKLER CONTRACTOR (SIGNED) DATE SIGNATURES 'PESTS WITNESSED BY TITLE DATE ' PART "C" - SPRINKLER & WATER SPRAY ABOVEGROUND PIPING (FILL OUT SEPARATE PART "C' FOR EACH RISERI I LOCATION ^ saves GDIG '' l TESTS HYDROSTATIC ALL PIPING.?7 / ? PNEUMATIC DRY PIPING DRAIN REQUIRED : . :.... vC......... EQUIPMENT OPERATION: ALL. SPRINKLERS OR MAKE MODEL SIZE. OUANTITY TEMPERATURE RATING " ?'_ 1&O 9 / l(o) " 12' 366 %? 1 SS JPpici+F SPRAY I _ ._ IL . CNL'Olla _ ?' b NOZZLES - - PIPE AND MATERIAL AND KIND CONFORMS TOrP F STANDARD SL I IF NONE, EXPLAIN FITTINGS - A L A R M D E V I C E MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VALVE OR FLOW MIN. _ SEC. TYPE MAKE -- MODEL INDICATOR_ `r nrl OPERATING TEST RESULTS: I ! O TIME DRY MAKE MODEL SEP. OIN WATER AIR TIIROUGH TUST PIPE POINT WATER ALARM NO. _ - - ) WITHOUT WITH PRESS. PRESS. AIR REACHED TEST OPERATED PROPERLY P O. O. D. Q_ O. D. PRESS. OUTLET IPE MIN. SEC. MIN. _ SEC PS .I. P.S.I. P.S.I. MIN.. SEC. Vey NO VALVES ? HNO LA IN OPERATION: rNaU MAnc ? uacn¢ ? PIVNIAULIC ? PIPING SUPERVISED: Yaa L', No ? DETECTING MEDIA SUPERVISED. Tu ? NO DELUGE DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS? Yaa (3 NO IS THERE AN ACCESSIBLE PACILTTY IN EACH CIRCUIT FOR TESTING? yp 0 NO p IF NO. EXPLAIN PPEACTION DOES EACH CIRCUIT OPERATE DOGS EACH CIRLTIIT OPERATE MAXIMUM TIME TO VALVES MAKE MODEL SUPERVISION LOSS ALARM! VALVE RELEASE1 OPERATE RELEASE. YES NO YES NO MIN. Sec. ALL PIPING HYDROSTATICALLY TESTED AT 2 , U PSI FOR HOURS DAY PIPING PNEUMATICALLY TESTED: - Tu ? No Q TESTS EQUIPMENT OPERATES PROPERLY: Yu ? No Q IF NO. STATE REASON DRAIN TEST: READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE RESIDUAL PRESSURE WITH VALVE IN TEST PIPE OPEN WIDE STATIC PRESSURE PSI NUMBER USED LOCATIONS NUMBER ReMOVeD BLANK TESTING W'EI.DED OR BRAZED PIPING Yu ? No IF YES, DO YOI? CERTIFY AS THE RPIIINKLMR CONTRACTOR THAT THE. WET.DRIlB OR RRAZERR ARE. QITAUVIED MR WEI.D- GASKETS INO OR ORA'LINO IN ACCORDANCE. WITH THE HEOIIIREMRNTH OF AHSIF. BOILER AND PRF.RNURE VRRREL CODE, NEX:TION IX. QUALIFICATION STANDARD FOR WELDING AND R ZLSO PROCEDURES, WKLDEILH, BRAZERM, AND WELDING AND BRAZING (WRRATOHR-19614 EDITION. YY O NO ? DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN. REMARKS - 2-,4 - 8 NAME OF SPRINKLER CONTRACTOR POR PQ WEER (SIGN I L8 PART "C" SIGNATURES FO0. SPRMKLl0 CONTRACTOR (SIGNED) I TESTS WITNESSED BY TITLE -1f-67 DATE i)' C!ty of Eaali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: !7�6 Date Received: Staff: ,tC-) 2012 COMMERCIAL BUILDING PERMIT APPLICATION Date: 7 /15/12- Site Address: l 54o -111-0 144 AS LA Lek- dot r 4T- It'll 2.--- AiNowiteur UNITS 11 (Tenant is: New / '/Existing) Suite #: Tenant Name: Former Tenant: PROPERTY OWNER Name: P6 M I WV M Phone: Address / City / Zip: (540 li-te.R4 NS t -brim- VT Applicant is: Owner /Contractor TYPE OF WORK Description of work: etrIA - (2) UEd SUPR5 r Construction Cost: # =6 . 6 0 CONTRACTOR Name: Vjil.D( INt, C artr ero icense #: &- 114 SS °5 Address: 74140 3VIJIGIkL_ Pb �(ap City: Bur- 4eAi1CL� it State: MN . Zip: **7 Phone: 452_ - 70 6115 Contact VK WI PPE Email: T # 3326 -I (AT) ARCHITECT/ ENGINEER Name: Registration #: Address: City: State: Zip: Phone: Contact Person: Email: Licensed plumber installing new sewer/water service: ^ Phone #: NOTE: Plans and supporting', documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case .f work which requires a review and approval of plans. x TERRY ) f m E11> Applicant's Printed Name , x App's ant's Si .yT. ture Page 1 of 3 Is - /3 -_T1,1� DO NOT WRITE BELOW THIS LINE /c)c—z/67 SUB TYPES Foundation Commercial / Industrial Apartments Miscellaneous WORK TYPES New Addition Alteration /Replace Salon Owner Change DESCRIPTION Valuation Plan Review (25% 100%t7) Census Code # of Units # of Buildings Type of Construction Public Facility Accessory Building Greenhouse / Tent Antennae Interior Improvement Exterior Improvement Repair Water Damage REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Occupancy Code Edition Zoning Stories Square Feet Length Width Roof: _Decking Insulation _Ice & Water Framing Fireplace: Rough In _Air Test Final Insulation Meter Size: Final Exterior Alteration -Apartments Exterior Alteration -Commercial Exterior Alteration -Public Facility Siding Reroof Windows Fire Repair Demolish Building* Demolish Interior Demolish Foundation Retaining Wall *Demolition of entire building - give PCA handout to applicant E. Z MCES System ZGp% M6,QG SAC Units City Water Booster Pump PRV Fire Sprinklers Sheetrbck Final / C.O. Required Final/ No C.O. Required Other: d/A, Pool: Footings _Air/Gas Tests Final Siding: _Stucco Lath Stone Lath Brick Windows Retaining Wall Erosion Control Final CIO Inspection: Schedule Fire Marshal to be present: Yes % No Reviewed By: , Building Inspector Reviewed By: , Planning COMMERCIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC S&W Permit & Surcharge Treatment Plant Treatment Plant (Irrigation) Park Dedication Trail Dedication Water Quality `sa •eb Water Quality Water Supply & Storage (WAC) Storm Sewer Trunk Sewer Trunk Water Trunk Street Lateral Street Water Lateral Other: TOTAL at/tt%.TO Page 2 of 3 LS-Li,t0,4s LG ict l e For Office Use ' n -16---6KD .1 % i �,,�I, _. ° D ::::: Q'D/ 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 Date Received: (651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 build inginspectionsCa.citVofeagan.com L Staff: J CROSS CONNECTION CONTROL PROGRAM INSPECTIONS PERMIT APPLICATION -Csg Tj 63 Z LAP- Date: 3/10/2020 Site Address: 1540 Thomas Pointe , Eagan, MN 55122 Tenant: THomas Lake Pointe Apartments Suite#: Property Owner Name: Nationwide Housing Corporation Phone: 763-512-7720 Name: Jayhawk Mechanical Inc PC644834 License#: Contractor Address: 3307 N 2nd St City: Minneapolis MN 55412 State: Zip: Phone: 612-522-3499 Email: jlee@jayhawkmechanical.com New f Replacement _Repair _Rebuild Type of Work Description of work: Replace backflow device with new RPZ. COMMERCIAL Irrigation System( yes/✓ no)(I RPZ/_PVB) Permit Type • Rain sensors required on irrigation systems • Avg.GPM (2"turbo required unless smaller size allowed by Public Works) Avg.GPM High demand devices? Yes No Flushometers Yes No Permit Fee $60.00 You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.com/subscribe. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan;that I understand this is not a permit,but only an application for a permit,and work is not to start without a permit;that the work will a in accordance with the approved plan in the case of work which requires a review and approval of plans. ,✓---'``'s, r Applicant's Printed Name .ppant . i Ti- e l